1669486908 NPI number — FORESIGHT CHIROPRACTIC PLC

Table of content: (NPI 1669486908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669486908 NPI number — FORESIGHT CHIROPRACTIC PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORESIGHT CHIROPRACTIC PLC
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:
FORESIGHT CHIROPRACTIC
Provider Other Organization Name Type Code:
3
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:
1669486908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2915 E BASELINE RD
Provider Second Line Business Mailing Address:
SUITE 126
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85234-2425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-325-6977
Provider Business Mailing Address Fax Number:
602-296-0487

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2915 E BASELINE RD
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85234-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-325-6977
Provider Business Practice Location Address Fax Number:
602-296-0487
Provider Enumeration Date:
07/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAVENDER
Authorized Official First Name:
IRA
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
480-325-6977

Provider Taxonomy Codes

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

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

  • Identifier: 1346422086 . This is a "DR. KEITH LAVENDER NPI #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0945100 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1245414564 . This is a "DR. WILLIAM JARMAN NPI #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0932280 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".