1225171960 NPI number — DR. LUCILE M STROM BAVERS D.C.

Table of content: DR. LUCILE M STROM BAVERS D.C. (NPI 1225171960)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225171960 NPI number — DR. LUCILE M STROM BAVERS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STROM BAVERS
Provider First Name:
LUCILE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STROM
Provider Other First Name:
LUCILE
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1225171960
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
230 BACKUS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEBOYGAN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49721-1504
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-627-6161
Provider Business Mailing Address Fax Number:
231-627-2921

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
230 BACKUS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEBOYGAN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49721-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-627-6161
Provider Business Practice Location Address Fax Number:
231-627-2921
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  LS007551 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P95208 . This is a "BLUE CROSS GREAT LAKES NE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 143482674 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 950A660960 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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