1326180969 NPI number — DANSAR LTD INC

Table of content: (NPI 1326180969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326180969 NPI number — DANSAR LTD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANSAR LTD 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:
ADVANCED CARE CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1326180969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
837 E POWELL BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRESHAM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97030-7617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-669-9495
Provider Business Mailing Address Fax Number:
503-669-8257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
837 E POWELL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRESHAM
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97030-7617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-669-9495
Provider Business Practice Location Address Fax Number:
503-669-8257
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VROOM
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT, CHIROPRACTOR
Authorized Official Telephone Number:
503-669-9495

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  27 2936 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 71 3666 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1215913637 . This is a "NPI-DR BRIAN L VROOM" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1316091275 . This is a "NPI-DR MICHELLE WAGGONER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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