1538172234 NPI number — FENTON CHIROPRACTIC PA

Table of content: (NPI 1538172234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538172234 NPI number — FENTON CHIROPRACTIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FENTON 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:
1538172234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 429
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAYLORSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28681-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-635-7400
Provider Business Mailing Address Fax Number:
282-635-7415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 7TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28681-2409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
282-635-7400
Provider Business Practice Location Address Fax Number:
828-635-7415
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FENTON
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
828-635-7400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2041 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0822G . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561971088 . This is a "CNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: EWNA78 . This is a "ACN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890822G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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