1164606737 NPI number — HEALTHBRIDGE CHIROPRACTIC

Table of content: (NPI 1164606737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164606737 NPI number — HEALTHBRIDGE CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHBRIDGE CHIROPRACTIC
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:
1164606737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1416 MARTIN MEADOWS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLSTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21047-2221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-877-1597
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
137 E BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-638-2424
Provider Business Practice Location Address Fax Number:
410-893-8923
Provider Enumeration Date:
12/19/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MENGES
Authorized Official First Name:
JASON
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
410-638-2424

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  01933 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NR0400X , with the licence number: 01933 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 639A-HE . This is a "BCBS PROVIDER GROUP #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 60485304 . This is a "BLUE SHIELD RENDERING ID#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J5830001 . This is a "BS FEP, BLUE CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".