1497758676 NPI number — DR. RUSSELL R VANHEMERT D.C., C.C.S.P.

Table of content: DR. RUSSELL R VANHEMERT D.C., C.C.S.P. (NPI 1497758676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497758676 NPI number — DR. RUSSELL R VANHEMERT D.C., C.C.S.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANHEMERT
Provider First Name:
RUSSELL
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C., C.C.S.P.
Provider Gender Code:
M

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:
1497758676
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/15/2006
NPI Reactivation Date:
03/29/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PELLA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50219-0026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-628-2099
Provider Business Mailing Address Fax Number:
641-628-2324

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PELLA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50219-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-628-2099
Provider Business Practice Location Address Fax Number:
641-628-2324
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  04934 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1710013719 . This is a "NPI CORPORATION NUMBER" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0231951 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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