1629276456 NPI number — OSCODA AREA CHIROPRACTIC CENTER

Table of content: MS. PAMELA JANE BLAIR NP (NPI 1184851446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629276456 NPI number — OSCODA AREA CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OSCODA AREA CHIROPRACTIC CENTER
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:
1629276456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5671 N SKEEL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSCODA
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-739-0077
Provider Business Mailing Address Fax Number:
989-739-2743

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5671 N SKEEL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSCODA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-739-0077
Provider Business Practice Location Address Fax Number:
989-739-2743
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TROMBLEY
Authorized Official First Name:
TERRY
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
989-739-0077

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301006829 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 14471587 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 95OC55002 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P78054 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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