1457570509 NPI number — INDUSTRIAL ATHLETES IN MOTION

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 1457570509 NPI number — INDUSTRIAL ATHLETES IN MOTION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INDUSTRIAL ATHLETES IN MOTION
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:
I-AIM
Provider Other Organization Name Type Code:
3
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:
1457570509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5060 CASCADE RD SE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-954-0950
Provider Business Mailing Address Fax Number:
616-954-1728

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5060 CASCADE RD SE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-954-0950
Provider Business Practice Location Address Fax Number:
616-954-1728
Provider Enumeration Date:
04/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PIECHOCKI
Authorized Official First Name:
JEN
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTING COORDINATOR
Authorized Official Telephone Number:
616-954-0950

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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