1093953374 NPI number — HUDSON FAMILY CHIROPRACTIC, PLC

Table of content: (NPI 1093953374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093953374 NPI number — HUDSON FAMILY CHIROPRACTIC, PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUDSON FAMILY CHIROPRACTIC, PLC
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:
1093953374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 366
Provider Second Line Business Mailing Address:
107 ELDORA RD.
Provider Business Mailing Address City Name:
HUDSON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50643-0366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-988-3336
Provider Business Mailing Address Fax Number:
319-988-3196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 ELDORA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50643-0366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-988-3336
Provider Business Practice Location Address Fax Number:
319-988-3196
Provider Enumeration Date:
01/26/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GROOTHUIS
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
LEROY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
319-988-3336

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  03028 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016899 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com