1326187816 NPI number — BAYVIEW CHIROPRACTIC LLC

Table of content: (NPI 1326187816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326187816 NPI number — BAYVIEW CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYVIEW CHIROPRACTIC LLC
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:
1326187816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 MIDDESSA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLETOWN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19709-6819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-378-2273
Provider Business Mailing Address Fax Number:
302-378-1183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 MIDDESSA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-6819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-378-2273
Provider Business Practice Location Address Fax Number:
302-378-1183
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITLOCK
Authorized Official First Name:
WELLINGTON
Authorized Official Middle Name:
SIMMONS
Authorized Official Title or Position:
OWNER CHIROPRACTOR
Authorized Official Telephone Number:
302-378-2273

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  F10000421 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2399337000 . This is a "AMERIHEALTH INDEP BCBS DE" identifier . This identifiers is of the category "OTHER".




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