1366525149 NPI number — VARDY CHIROPRACTIC AND WELLNESS CLINICS

Table of content: (NPI 1366525149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366525149 NPI number — VARDY CHIROPRACTIC AND WELLNESS CLINICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VARDY CHIROPRACTIC AND WELLNESS CLINICS
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:
WENDELL FAMILY 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:
1366525149
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 92
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENDELL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27591-0092
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-366-3111
Provider Business Mailing Address Fax Number:
919-366-3366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2825 WENDELL BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENDELL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-366-3111
Provider Business Practice Location Address Fax Number:
919-366-3366
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VARDY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
919-366-3111

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 017N6 . This is a "BCBS GROUP #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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