1902934193 NPI number — GARY WADE NOLAN DC

Table of content: GARY WADE NOLAN DC (NPI 1902934193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902934193 NPI number — GARY WADE NOLAN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAN
Provider First Name:
GARY
Provider Middle Name:
WADE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1902934193
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3315 ALMADEN EXPY
Provider Second Line Business Mailing Address:
STE 29
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-384-1519
Provider Business Mailing Address Fax Number:
408-384-1519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 ALMADEN EXPY
Provider Second Line Business Practice Location Address:
STE 29
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95118-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-384-1519
Provider Business Practice Location Address Fax Number:
408-604-0166
Provider Enumeration Date:
03/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC 30783 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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