1932249562 NPI number — COOPERATIVE CHIROPRACTIC

Table of content: (NPI 1932249562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932249562 NPI number — COOPERATIVE CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOPERATIVE 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:
DR. RAY MARQUEZ
Provider Other Organization Name Type Code:
5
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:
1932249562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1651 POWDER SPRINGS RD SW
Provider Second Line Business Mailing Address:
SUITE 3
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30064-4847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-422-5052
Provider Business Mailing Address Fax Number:
770-422-8227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1651 POWDER SPRINGS RD SW
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30064-4847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-422-5052
Provider Business Practice Location Address Fax Number:
770-422-8227
Provider Enumeration Date:
02/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CORRIGAN
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
770-422-5052

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  007145 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 007157 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1255384798 . This is a "NPI- DR. MURRAY-GREEN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 151709061 . This is a "DR. M TAX ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1720172430 . This is a "NPI-DR. MARQUEZ" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".