1417954884 NPI number — DR. ALAN SCHWARTZ D.C.

Table of content: DR. ALAN SCHWARTZ D.C. (NPI 1417954884)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417954884 NPI number — DR. ALAN SCHWARTZ D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
ALAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1417954884
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/25/2006
NPI Reactivation Date:
06/28/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
504 S BROOKHURST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92804-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-533-1813
Provider Business Mailing Address Fax Number:
714-533-0618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
504 S BROOKHURST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92804-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-533-1813
Provider Business Practice Location Address Fax Number:
714-533-0618
Provider Enumeration Date:
06/30/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  12533 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: T04796 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".