1174692826 NPI number — ADRIAN NOHR DC, PSC

Table of content: (NPI 1174692826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174692826 NPI number — ADRIAN NOHR DC, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADRIAN NOHR DC, PSC
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:
CROSSROADS CHIROPRACTIC AND WELLNESS CENTER
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:
1174692826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2626 RING RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ELIZABETHTOWN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42701-9118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-765-2244
Provider Business Mailing Address Fax Number:
270-765-2485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2626 RING RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-9118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-2244
Provider Business Practice Location Address Fax Number:
270-765-2485
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NOHR
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT CHIROPRACTOR
Authorized Official Telephone Number:
270-765-2244

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4740 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000502350 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 0007527422 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50013896 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85003010 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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