1063575546 NPI number — ANDEN CHIROPRACTIC CLINIC

Table of content: (NPI 1063575546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063575546 NPI number — ANDEN CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDEN CHIROPRACTIC CLINIC
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:
Provider Other Organization Name Type Code:
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:
1063575546
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
193 FINLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLE VERNON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15012-3822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-930-8060
Provider Business Mailing Address Fax Number:
724-930-8083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
193 FINLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLE VERNON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15012-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-930-8060
Provider Business Practice Location Address Fax Number:
724-930-8083
Provider Enumeration Date:
12/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDEN
Authorized Official First Name:
DANA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-930-8060

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC0006158L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 995549 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2693544 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7902317 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 894308 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1041004 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 81942 . This is a "UNISON HEALTH PLAN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 11170954 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3322040 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016165810002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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