1518117365 NPI number — KIBBY CHIROPRACTIC CENTER, PC

Table of content: (NPI 1518117365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518117365 NPI number — KIBBY CHIROPRACTIC CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIBBY CHIROPRACTIC CENTER, PC
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:
1518117365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2110 PRIEST BRIDGE DR
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
CROFTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21114-2472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-721-5050
Provider Business Mailing Address Fax Number:
301-858-1608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2110 PRIEST BRIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
CROFTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21114-2472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-721-5050
Provider Business Practice Location Address Fax Number:
301-858-1608
Provider Enumeration Date:
09/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIBBY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-721-5050

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  S01438 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: T88812 . This is a "UPIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 42443403 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T205001 . This is a "CAREFIRST DC FEP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LX18KI . This is a "CAREFIRST MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".