1437115748 NPI number — DR. BRIDGET A GUTZMER D.C

Table of content: ELIZABETH CARNACCHI (NPI 1417701913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437115748 NPI number — DR. BRIDGET A GUTZMER D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTZMER
Provider First Name:
BRIDGET
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
Provider Gender Code:
F

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:
1437115748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 E SUGAR CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28213-6913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-405-7000
Provider Business Mailing Address Fax Number:
704-405-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 E SUGAR CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28213-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-405-7000
Provider Business Practice Location Address Fax Number:
704-405-7001
Provider Enumeration Date:
04/25/2006

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:  CH3051 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 4358 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GCH489 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203191494 . This is a "CHIROPRACTIC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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