1457672255 NPI number — MURRAY CHIROPRACTIC CLINIC INC

Table of content: (NPI 1457672255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457672255 NPI number — MURRAY CHIROPRACTIC CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MURRAY CHIROPRACTIC CLINIC INC
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:
1457672255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 22ND AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKINGS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57006-2822
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-697-5090
Provider Business Mailing Address Fax Number:
605-697-5090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 22ND AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKINGS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57006-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-697-5090
Provider Business Practice Location Address Fax Number:
605-697-5090
Provider Enumeration Date:
06/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MERTZ
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CLINIC COORDINATOR
Authorized Official Telephone Number:
605-697-5090

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  708 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3K028MU . This is a "BLUE CROSS BLUE SHIELD OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0080133 . This is a "WELLMARK BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: CASD2 . This is a "SANFORD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: CASD1 . This is a "DAKOTACARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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