1013179852 NPI number — STEVEN COHN DC PA

Table of content: (NPI 1013179852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013179852 NPI number — STEVEN COHN DC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN COHN DC PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BACK IN LINE FAMILY CHIROPRACTIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013179852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11500 HIGHWAY 7
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55305-5173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-933-2663
Provider Business Mailing Address Fax Number:
952-933-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11500 HIGHWAY 7
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55305-5173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-933-2663
Provider Business Practice Location Address Fax Number:
952-933-2673
Provider Enumeration Date:
07/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COHN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MARC
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
952-933-2663

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4025 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C03541 . This is a "GROUP MEDICARE ID" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com