1205279254 NPI number — LIFESTREAM CHIROPRACTIC CLINIC

Table of content: ANNA DARVIN HIRSCH MS, LMFT (NPI 1184171845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205279254 NPI number — LIFESTREAM CHIROPRACTIC CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFESTREAM CHIROPRACTIC CLINIC
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:
1205279254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7195 NW 54TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
URBANDALE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50322-6915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-210-9128
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7195 NW 54TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
URBANDALE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50322-6915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-210-9128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
O'TOOL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
563-210-9128

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  007623 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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