1417240177 NPI number — CROSBY CHIROPRACTIC CENTER, INC

Table of content: (NPI 1417240177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417240177 NPI number — CROSBY CHIROPRACTIC CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSBY CHIROPRACTIC CENTER, 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:
1417240177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4508 OUTER LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40219-3857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-969-3121
Provider Business Mailing Address Fax Number:
502-969-4570

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4508 OUTER LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40219-3857
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-969-3121
Provider Business Practice Location Address Fax Number:
502-969-4570
Provider Enumeration Date:
05/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CROSBY
Authorized Official First Name:
BING
Authorized Official Middle Name:
G
Authorized Official Title or Position:
CEO - CHIROPRACTIC
Authorized Official Telephone Number:
502-969-3121

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com