=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881104453
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COY CHIROPRACTIC INSTITUTE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2017
-----------------------------------------------------
Last Update Date | 10/09/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7444 FLORENCE AVE STE H
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90240-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-528-1113
-----------------------------------------------------
Fax | 562-776-1745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7444 FLORENCE AVE STE H
-----------------------------------------------------
City | DOWNEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90240-3600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 563-528-1113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. ANTHONY B. DEXTER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 563-528-1113
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 34042
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------