1447490495 NPI number — EATON RAPIDS CHIROPRACTIC PSC

Table of content: (NPI 1447490495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447490495 NPI number — EATON RAPIDS CHIROPRACTIC PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EATON RAPIDS CHIROPRACTIC PSC
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:
1447490495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 S MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EATON RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48827-1075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-663-7000
Provider Business Mailing Address Fax Number:
517-663-5427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EATON RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48827-1075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-663-7000
Provider Business Practice Location Address Fax Number:
517-663-5427
Provider Enumeration Date:
03/04/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ALBRECHT
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
517-663-7000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301006760 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: U22980 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P101961 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 950B310670 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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