1790984516 NPI number — CARY BANEY

Table of content: (NPI 1790984516)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790984516 NPI number — CARY BANEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARY BANEY
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:
COUNTY CHIROPRACTIC
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:
1790984516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 W 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63361-1813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-564-3600
Provider Business Mailing Address Fax Number:
573-564-3600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 W 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63361-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-564-3600
Provider Business Practice Location Address Fax Number:
573-564-3600
Provider Enumeration Date:
07/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BANEY
Authorized Official First Name:
CARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-564-3600

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2001012377 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 143494 . This is a "BLUE CROSS MISSOUR" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1497757280 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 466683 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 629911 . This is a "ACN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".