1295935252 NPI number — BALLARD CENTRAL CHIROPRACTIC INC

Table of content: (NPI 1295935252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295935252 NPI number — BALLARD CENTRAL CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BALLARD CENTRAL 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:
1295935252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5409 17TH AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98107-3818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-784-3895
Provider Business Mailing Address Fax Number:
206-784-7471

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5409 17TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98107-3818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-784-3895
Provider Business Practice Location Address Fax Number:
206-784-7471
Provider Enumeration Date:
07/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLENK
Authorized Official First Name:
BRODIE
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-784-3895

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00034175 , registered in the state of WA ; 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