1154521649 NPI number — CHIROPRACTIC CENTER OF SOUTH COUNTY,INC.

Table of content: DR. LOUIS IGNATIUS YBOS III DDS (NPI 1548314032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154521649 NPI number — CHIROPRACTIC CENTER OF SOUTH COUNTY,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC CENTER OF SOUTH COUNTY,INC.
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:
1154521649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EXECUTIVE BLDG
Provider Second Line Business Mailing Address:
118 POINT JUDITH RD
Provider Business Mailing Address City Name:
NARRAGANSETT
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02882-3439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-783-2937
Provider Business Mailing Address Fax Number:
401-782-3620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
EXECUTIVE BLDG
Provider Second Line Business Practice Location Address:
118 POINT JUDITH RD
Provider Business Practice Location Address City Name:
NARRAGANSETT
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02882-3439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-783-2937
Provider Business Practice Location Address Fax Number:
401-782-3620
Provider Enumeration Date:
07/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TARTARO
Authorized Official First Name:
JEROME
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT/CHIROPRACTOR
Authorized Official Telephone Number:
401-783-2937

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  DCP00246 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9022-5 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4400018 . This is a "UNITED" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 408912 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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