1588795777 NPI number — MRS. MARY T A SPOHN-CARLE DOM, L.AC.

Table of content: MRS. MARY T A SPOHN-CARLE DOM, L.AC. (NPI 1588795777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588795777 NPI number — MRS. MARY T A SPOHN-CARLE DOM, L.AC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPOHN-CARLE
Provider First Name:
MARY
Provider Middle Name:
T A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DOM, L.AC.
Provider Gender Code:
F

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:
1588795777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12611 N 103RD AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SUN CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85351-3422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-815-3306
Provider Business Mailing Address Fax Number:
623-815-6848

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12611 N 103RD AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85351-3422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-815-3306
Provider Business Practice Location Address Fax Number:
623-815-6848
Provider Enumeration Date:
03/08/2007

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: 171100000X , with the licence number:  0141 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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