=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922177450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MMJS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 04/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 550 OHIO PIKE SUITE 121-F
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-947-9355
-----------------------------------------------------
Fax | 513-947-0190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 OHIO PIKE SUITE 121-F
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45255-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-947-9355
-----------------------------------------------------
Fax | 513-947-0190
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTIC PYSICIAN
-----------------------------------------------------
Name | JEFFREY S. HAYMES
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 513-947-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2690
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------