1184782963 NPI number — MCCALL CHIROPRACTIC INC.

Table of content: (NPI 1184782963)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184782963 NPI number — MCCALL CHIROPRACTIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCALL CHIROPRACTIC INC.
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:
1184782963
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 931
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCCALL
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-634-8271
Provider Business Mailing Address Fax Number:
208-634-8271

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 E PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCCALL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83638-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
86-348-2712
Provider Business Practice Location Address Fax Number:
208-634-3526
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JEPPE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
GUY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-634-8271

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIA914 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C1773 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010028703 . This is a "REGENCE BL SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com