1053385013 NPI number — DR. CRYSTAL LEE PADEN D.C.

Table of content: MADELINE DEPASCALE AUD (NPI 1497481329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053385013 NPI number — DR. CRYSTAL LEE PADEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADEN
Provider First Name:
CRYSTAL
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1053385013
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 E. CHERRY ST. #106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERMILLION
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57069-1217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-624-9483
Provider Business Mailing Address Fax Number:
605-624-9687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E. CHERRY ST. #106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERMILLION
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57069-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-624-9483
Provider Business Practice Location Address Fax Number:
605-624-9687
Provider Enumeration Date:
02/15/2006

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: 111N00000X , with the licence number:  985 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 1348 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 100252238-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22354 . This is a "SIOUX VALLEY HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6889 . This is a "AVERA NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 7601520 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 239570 . This is a "MIDLANDS CHOICE NUMBER" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 0040463 . This is a "WELLMARK PROVIDER NUMBER" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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