1437625365 NPI number — RUSSELL CHIROPRACTIC AND SPORTS THERAPY PA

Table of content: (NPI 1437625365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437625365 NPI number — RUSSELL CHIROPRACTIC AND SPORTS THERAPY PA

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
RUSSELL CHIROPRACTIC AND SPORTS THERAPY PA
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:
1437625365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
138 W 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELL
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67665-1905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-483-5356
Provider Business Mailing Address Fax Number:
785-483-3535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
138 W 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSSELL
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67665-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-483-5356
Provider Business Practice Location Address Fax Number:
785-483-3535
Provider Enumeration Date:
10/18/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GALLION
Authorized Official First Name:
LINDSAY
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OWNER/CHIROPRACTOR
Authorized Official Telephone Number:
785-483-5356

Provider Taxonomy Codes

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

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

  • Identifier: 1699100685 . This is a "NPI" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".