1013928365 NPI number — DR. CHRISTINE CELESTE KANCIUS DPM

Table of content: MRS. CHELSEA M. CEPIK (NPI 1477000396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013928365 NPI number — DR. CHRISTINE CELESTE KANCIUS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANCIUS
Provider First Name:
CHRISTINE
Provider Middle Name:
CELESTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

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:
1013928365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3827 N PROSPECT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-686-1000
Provider Business Mailing Address Fax Number:
309-686-8174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-263-1017
Provider Business Practice Location Address Fax Number:
309-266-5864
Provider Enumeration Date:
08/11/2006

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: 213E00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA0891 . This is a "PALMETTO GBA- RAILROAD ME" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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