1568634160 NPI number — TOTAL BODY CHIROPRACTIC CLINIC, INC.

Table of content: MR. KENNETH ALFORD R.PH (NPI 1841528783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568634160 NPI number — TOTAL BODY CHIROPRACTIC CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOTAL BODY CHIROPRACTIC CLINIC, 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:
1568634160
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
KAMAS
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84036-9597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-783-2838
Provider Business Mailing Address Fax Number:
435-783-2840

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KAMAS
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84036-9597
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-783-2838
Provider Business Practice Location Address Fax Number:
435-783-2840
Provider Enumeration Date:
03/24/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
RACHEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
435-783-2838

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)

  • Identifier: 67337 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 50499451200001 . This is a "REGENCE BCBS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000056512 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 50499451277001 . This is a "FEDERAL BCBS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 870395551005 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".