1003862087 NPI number — ALLIED HEALTH CHIROPRACTIC CENTERS OF IL, LLC

Table of content: (NPI 1003862087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003862087 NPI number — ALLIED HEALTH CHIROPRACTIC CENTERS OF IL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIED HEALTH CHIROPRACTIC CENTERS OF IL, LLC
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:
ALLIED HEALTH CHIROPRACTIC CENTERS
Provider Other Organization Name Type Code:
3
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:
1003862087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S 32ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUSAU
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54401-3958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-848-2526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S 32ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAUSAU
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54401-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-848-2526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAUTCH
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
715-848-2526

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CK7346 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: CK6783 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 07232019 . This is a "BLUE CROSS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com