1386691699 NPI number — ROMAN FAMILY CHIRO PLLC

Table of content: (NPI 1386691699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386691699 NPI number — ROMAN FAMILY CHIRO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROMAN FAMILY CHIRO PLLC
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:
1386691699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2584 PATTERSON RD SUITE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81505-1445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-243-8896
Provider Business Mailing Address Fax Number:
970-245-1511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2584 PATTERSON RD SUITE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81505-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-243-8896
Provider Business Practice Location Address Fax Number:
970-245-1511
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROMAN
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
970-243-8896

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4818 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 639772 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com