1184031908 NPI number — EBERLE-REAGAN, INC

Table of content: (NPI 1184031908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184031908 NPI number — EBERLE-REAGAN, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EBERLE-REAGAN, 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:
6
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:
1184031908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13396 PRESTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-5208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7951 COLLIN MCKINNEY PKWY
Provider Second Line Business Practice Location Address:
STE 1500
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-7823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-398-6419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
REAGAN
Authorized Official First Name:
CAMILLE
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
972-503-7272

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  9065 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0016QU . This is a "BLUE CROSS BLUE SHIELD GROUP ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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