1134298979 NPI number — TIMOTHY R MCMULLEN DC PC

Table of content: (NPI 1134298979)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134298979 NPI number — TIMOTHY R MCMULLEN DC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIMOTHY R MCMULLEN DC PC
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:
MCMULLEN CHIROPRACTIC CENTER, PC
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:
1134298979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1508 MISSOURI ROUTE A
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64068-7129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-781-1010
Provider Business Mailing Address Fax Number:
816-415-8487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1508 MISSOURI ROUTE A
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64068-7129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-781-1010
Provider Business Practice Location Address Fax Number:
816-415-8487
Provider Enumeration Date:
11/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCMULLEN
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
CORPORATE PRESIDENT
Authorized Official Telephone Number:
816-781-1010

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  006657 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7070138 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 25314026 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: U70653 . This is a "HUMANA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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