1720094485 NPI number — DOKLAN CHIROPRACTIC

Table of content: (NPI 1720094485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720094485 NPI number — DOKLAN CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOKLAN CHIROPRACTIC
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:
1720094485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1941 BELLEVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITEHALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18052-3744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-799-2489
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1259 S CEDAR CREST BLVD
Provider Second Line Business Practice Location Address:
SUITE 317
Provider Business Practice Location Address City Name:
ALLENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18103-6372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-774-0445
Provider Business Practice Location Address Fax Number:
610-774-0448
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOKLAN
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
CLINTON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-774-0445

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  DC007371L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50044086 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7484644 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 421158 . This is a "HEALTH ASSURANCE/COVENTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1037855 . This is a "AMERICAN SPECIALITY HEALT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2356247000 . This is a "INDEPENDENCE BLUR CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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