=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972031656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRUE LIFE CHIROPRACTIC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 599 HARRY SAUNER RD STE C
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45133-7631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-666-0408
-----------------------------------------------------
Fax | 937-913-3052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 599 HARRY SAUNER RD STE C
-----------------------------------------------------
City | HILLSBORO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45133-7631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-666-0408
-----------------------------------------------------
Fax | 937-913-3052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO OWNER
-----------------------------------------------------
Name | DR. AUSTIN TRUEBLOOD
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 513-666-0408
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 4701
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------