1205026176 NPI number — HART CARE CHIROPRACTIC CENTER

Table of content: (NPI 1205026176)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205026176 NPI number — HART CARE CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HART CARE CHIROPRACTIC CENTER
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:
1205026176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W MAIN ST
Provider Second Line Business Mailing Address:
PO BOX 308
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63334-1561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
537-324-2225
Provider Business Mailing Address Fax Number:
537-324-6250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63334-1561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-324-2225
Provider Business Practice Location Address Fax Number:
573-324-6250
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HART
Authorized Official First Name:
L
Authorized Official Middle Name:
SHANE
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
573-324-2225

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  005241 , 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: CE005241 . This is a "WORKERS COMP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 22424 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 22424 . This is a "BLUECROSS BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: T43528 . This is a "MEDICARE DME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 178192 . This is a "PPO/HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5227583 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4450040 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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