1700958014 NPI number — CHIROPRACTIC HEALTH CENTER OF GARNER PA

Table of content: (NPI 1700958014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700958014 NPI number — CHIROPRACTIC HEALTH CENTER OF GARNER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC HEALTH CENTER OF GARNER PA
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:
HOSEY-SAUNDERS CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
4
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:
1700958014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 UMSTEAD LN.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-3099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-779-2424
Provider Business Mailing Address Fax Number:
919-779-5235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 UMSTEAD LN.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-779-2424
Provider Business Practice Location Address Fax Number:
919-779-5235
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAUNDERS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
EILEEN
Authorized Official Title or Position:
DC
Authorized Official Telephone Number:
919-779-2424

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1780 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0839A . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890839A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330685 . This is a "ACN MCO - CIGNA AND UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 350041947 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 738056 . This is a "MAMSI PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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