1659458545 NPI number — NARDONE CHIROPRACTIC,NORTH,PLLC

Table of content: (NPI 1659458545)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659458545 NPI number — NARDONE CHIROPRACTIC,NORTH,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NARDONE CHIROPRACTIC,NORTH,PLLC
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:
1659458545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MELINDA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTERSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43953-4049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-639-9166
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 B THREE SPRINGS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEIRTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26062-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-723-2494
Provider Business Practice Location Address Fax Number:
304-723-2301
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NARDONE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
304-723-2494

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  765 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2203034000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164417754 . This is a "NPI" identifier . This identifiers is of the category "OTHER".