1396940045 NPI number — ALTOONA CHIROPRACTIC CENTER PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396940045 NPI number — ALTOONA CHIROPRACTIC CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTOONA CHIROPRACTIC CENTER PC
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:
1396940045
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 2ND AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALTOONA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50009-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-967-3996
Provider Business Mailing Address Fax Number:
515-967-6809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 2ND AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALTOONA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50009-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-967-3996
Provider Business Practice Location Address Fax Number:
515-967-6809
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WILLSON
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
515-967-3996

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  04459 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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