1528088333 NPI number — BREAKFAST HILL CHIROPRACTIC, PLLC

Table of content: (NPI 1528088333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528088333 NPI number — BREAKFAST HILL CHIROPRACTIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BREAKFAST HILL 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:
1528088333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1247 WASHINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RYE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03870-2346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-964-1500
Provider Business Mailing Address Fax Number:
603-964-1591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1247 WASHINGTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RYE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03870-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-964-1500
Provider Business Practice Location Address Fax Number:
603-964-1591
Provider Enumeration Date:
07/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
603-964-1500

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  254-0496 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8733835 . This is a "CIGNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0508915Y0NH02 . This is a "BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".