1518190545 NPI number — BURGESS CHIROPRACTIC PA

Table of content: (NPI 1518190545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518190545 NPI number — BURGESS CHIROPRACTIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BURGESS CHIROPRACTIC 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:
1518190545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 DALLAS DR STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76205-5121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-243-0108
Provider Business Mailing Address Fax Number:
940-387-3446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 DALLAS DR STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76205-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-243-0108
Provider Business Practice Location Address Fax Number:
940-387-3446
Provider Enumeration Date:
08/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BURGESS
Authorized Official First Name:
CHARLOTTE
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
940-243-0108

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  9347 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11195715 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1891816716 . This is a "WELLCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8H9157 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1891816716 . This is a "INTEGRATED HEALTH PLAN, INC." identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1891816716 . This is a "FIRST HEALTH (COVENTRY)" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1549388-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1891816716 . This is a "PHCS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1891816716 . This is a "HUMANA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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