1588628473 NPI number — DR. COREY MICHAEL VAN WESTEN D.C.

Table of content: ALICIA KORONA (NPI 1821470386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588628473 NPI number — DR. COREY MICHAEL VAN WESTEN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN WESTEN
Provider First Name:
COREY
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1588628473
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15850 W BLUEMOUND RD
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
BROOKFIELD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53005-6022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-226-8349
Provider Business Mailing Address Fax Number:
262-226-8352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15850 W BLUEMOUND RD
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
BROOKFIELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53005-6022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-226-8349
Provider Business Practice Location Address Fax Number:
262-226-8352
Provider Enumeration Date:
04/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  4410-12 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1275814345 . This is a "GROUP NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 15886284733 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 100002627 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 39576 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".