=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881863751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ZABAWA CHIROPRACTIC PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2008
-----------------------------------------------------
Last Update Date | 02/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2831 RINGLING BLVD A102
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-4711
-----------------------------------------------------
Fax | 941-955-9986
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2831 RINGLING BLVD A102
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34237-5334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-4711
-----------------------------------------------------
Fax | 941-955-9986
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING REPRESENTATIVE
-----------------------------------------------------
Name | MRS. DEBORAH HILDERLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-232-0470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CH9408
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------