=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942698964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARBY WELLNESS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2014
-----------------------------------------------------
Last Update Date | 12/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 S WELLS ST APT 1324
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-635-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 800 S WELLS ST APT 1324
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60607-4541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-635-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. JUANITA DARBY
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 312-635-9355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 038012708
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------