=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902106859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUNPHY WELLNESS CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/26/2010
-----------------------------------------------------
Last Update Date | 03/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2745 S 6TH ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62703-4071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-528-9771
-----------------------------------------------------
Fax | 217-528-9777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2745 S 6TH ST
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62703-4071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-528-9771
-----------------------------------------------------
Fax | 217-528-9777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEVEN LEE DUNPHY
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 217-528-9771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038011337
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------