1114514148 NPI number — JOSEPH CHEN MD REHAB MEDICINE & PAIN COACHING LLC

Table of content: REBECCA JILL CRAIG LPC (NPI 1437378924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114514148 NPI number — JOSEPH CHEN MD REHAB MEDICINE & PAIN COACHING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH CHEN MD REHAB MEDICINE & PAIN COACHING 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:
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:
1114514148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 WILD ROSE LN # 4071
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-5350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-661-6236
Provider Business Mailing Address Fax Number:
515-661-6101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 WILD ROSE LN # 4071
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-5350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-661-6236
Provider Business Practice Location Address Fax Number:
515-661-6101
Provider Enumeration Date:
12/23/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
515-661-6236

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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