1649444126 NPI number — PAQUIN CHIROPRACTIC P.C.

Table of content: KORAL ELIZABETH NIETO RBT (NPI 1952167223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649444126 NPI number — PAQUIN CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAQUIN CHIROPRACTIC P.C.
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:
1649444126
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 S INDUSTRIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALINE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48176-9493
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-944-8484
Provider Business Mailing Address Fax Number:
734-944-8686

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 S INDUSTRIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48176-9493
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-944-8484
Provider Business Practice Location Address Fax Number:
734-944-8686
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PAQUIN
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
734-944-8484

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  TP007301 , 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: 95-0H11245-0 . This is a "BC/BSM PROVIDER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: TP007301 . This is a "STATE LICENCE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: N90410003 . This is a "COMMON PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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