1932239423 NPI number — BASLER CHIROPRACTIC CENTER, INC.

Table of content: (NPI 1932239423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932239423 NPI number — BASLER CHIROPRACTIC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BASLER CHIROPRACTIC CENTER, 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:
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:
1932239423
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02904-5752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-421-9695
Provider Business Mailing Address Fax Number:
401-331-1550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02904-5752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-421-9695
Provider Business Practice Location Address Fax Number:
401-331-1550
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BASLER
Authorized Official First Name:
MARY
Authorized Official Middle Name:
GRACE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
401-421-9695

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DCP00294 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 204246 . This is a "BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3542-2 . This is a "BLUE CROSS & BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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