1235396193 NPI number — TRINITY CHIROPRACTIC, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235396193 NPI number — TRINITY CHIROPRACTIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRINITY CHIROPRACTIC, PLLC
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:
1235396193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4583 NORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMESVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13078-9461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-469-9120
Provider Business Mailing Address Fax Number:
315-469-9124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4583 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13078-9461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-469-9120
Provider Business Practice Location Address Fax Number:
315-469-9124
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MIRANDA
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
315-469-9120

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X010412-2 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000144576 . This is a "EXCELLUS BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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