1568523934 NPI number — PINCONNING AREA CHIROPRACTIC CENTER INC

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 1568523934 NPI number — PINCONNING AREA CHIROPRACTIC CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINCONNING AREA 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:
1568523934
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 706
Provider Second Line Business Mailing Address:
1948 N HURON RD
Provider Business Mailing Address City Name:
PINCONNING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48650-7909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-879-8133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1948 N HURON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINCONNING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48650-7909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-879-8133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TROMBLEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
989-879-8133

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301008083 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 44707 . This is a "MOLINA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00074807 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P109392 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1009925 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4458898 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950Z950250 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com