1891974911 NPI number — MUSTANG CHIROPRACTIC

Table of content: (NPI 1891974911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891974911 NPI number — MUSTANG CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MUSTANG 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:
1891974911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11500 HIGHWAY 7
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
MINNETONKA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55305-5173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-760-4555
Provider Business Mailing Address Fax Number:
952-933-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11500 HIGHWAY 7
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MINNETONKA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55305-5173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-760-4555
Provider Business Practice Location Address Fax Number:
952-933-2673
Provider Enumeration Date:
10/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WORKMAN
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
612-760-4555

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC3629 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DC3629 . This is a "MN STATE LIC#" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: V73159 . This is a "UPIN#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01B13MU . This is a "BCBS GROUP#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01B14WO . This is a "BCBS ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1790838332 . This is a "INDIVIDUAL NPI#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 562 . This is a "HSM ID#" identifier . This identifiers is of the category "OTHER".