=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861803678
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL CHIROPACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2014
-----------------------------------------------------
Last Update Date | 05/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6715 N PALM AVE SUITE 114
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93704-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-991-3732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6715 N PALM AVE SUITE 114
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93704-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-991-3732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ALEX LIA LEE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 559-991-3732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | DC30377
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------