1891963765 NPI number — BACK PAIN SOLUTIONS INC.

Table of content: (NPI 1891963765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891963765 NPI number — BACK PAIN SOLUTIONS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK PAIN SOLUTIONS 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:
JAY KENNEDY DC
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:
1891963765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 DIAMOND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15530-1539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
181-426-7830
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 DIAMOND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15530-1539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
181-426-7830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KENNNEDY
Authorized Official First Name:
JAY
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
814-267-5830

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  DC003949L , 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: 2058294 . This is a "AETNA HMO/POS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 216978 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1508429 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01162738 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4281751 . This is a "AETNA PPO/POS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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