=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972820470
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR DAVID W POOL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2010
-----------------------------------------------------
Last Update Date | 08/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2403 SANTA FE DR
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81006-1497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-543-7894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2403 SANTA FE DR
-----------------------------------------------------
City | PUEBLO
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81006-1497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-543-7894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. DAVID POOL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 719-543-7894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | 3666
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------