1235303744 NPI number — LOTH SPORTS & FAMILY CHIROPRACTIC INC

Table of content: (NPI 1235303744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235303744 NPI number — LOTH SPORTS & FAMILY CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOTH SPORTS & FAMILY CHIROPRACTIC 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:
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:
1235303744
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 W ELLIOT RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85233-5129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-812-9000
Provider Business Mailing Address Fax Number:
480-812-9040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 W ELLIOT RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85233-5129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-812-9000
Provider Business Practice Location Address Fax Number:
480-812-9040
Provider Enumeration Date:
04/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOTH
Authorized Official First Name:
JASON
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
480-812-9000

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  5900 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com