1730299025 NPI number — BART CHIROPRACTIC PC

Table of content: (NPI 1730299025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730299025 NPI number — BART CHIROPRACTIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BART CHIROPRACTIC PC
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:
SHELDON FAMILY CHIROPRACTIC CLINIC
Provider Other Organization Name Type Code:
3
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:
1730299025
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
910 EAST PARK STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELDON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51201-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-324-4994
Provider Business Mailing Address Fax Number:
712-324-3710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 EAST PARK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELDON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51201-1275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-324-4994
Provider Business Practice Location Address Fax Number:
712-324-3710
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BART
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
712-324-4994

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  A05481 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21568 . This is a "SIOUX VALLEY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: C05481 . This is a "DAKOTA CARE DESIGN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2294553 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7262 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9204458 . This is a "DAKOTA CARE DESIGN GRP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58536 . This is a "WELLMARK BLUE CROSS" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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