=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871823518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AGUAYO CHIROPRACTIC & WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2009
-----------------------------------------------------
Last Update Date | 12/31/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2212 BROADWATER AVE SUITE D
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-4779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-294-5777
-----------------------------------------------------
Fax | 406-294-5778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2212 BROADWATER AVE SUITE D
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-4779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-294-5777
-----------------------------------------------------
Fax | 406-294-5778
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. JASON AGUAYO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 406-294-5777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1132
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------