1366432627 NPI number — ACTION CHIROPRACTIC & P.T., INC.

Table of content: (NPI 1366432627)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366432627 NPI number — ACTION CHIROPRACTIC & P.T., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTION CHIROPRACTIC & P.T., 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:
1366432627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
870 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01103-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-734-7277
Provider Business Mailing Address Fax Number:
413-734-7879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
870 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01103-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-734-7277
Provider Business Practice Location Address Fax Number:
413-734-7879
Provider Enumeration Date:
10/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MASLAR
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
413-734-7277

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 704317 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9713590 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y61354 . This is a "BLUECROSS/BLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0026208 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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