1649464793 NPI number — EATON CHIROPRACTIC INC

Table of content: (NPI 1649464793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649464793 NPI number — EATON CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EATON CHIROPRACTIC 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:
1649464793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 DEAN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAUNTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02780-2717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-823-2697
Provider Business Mailing Address Fax Number:
508-824-4559

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 DEAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAUNTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02780-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-823-2697
Provider Business Practice Location Address Fax Number:
508-824-4559
Provider Enumeration Date:
08/31/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EATON
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
508-823-2697

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH 37CF , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2329777 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 351312 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y39397 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 776828 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".