1700136751 NPI number — PODEY FAMILY & SPORTS CHIROPRACTIC

Table of content: EDDIE ROBERT BARNES DO (NPI 1417539156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700136751 NPI number — PODEY FAMILY & SPORTS CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODEY FAMILY & SPORTS CHIROPRACTIC
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:
1700136751
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
714 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANNING
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51455-1008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
712-655-3242
Provider Business Mailing Address Fax Number:
712-655-2871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANNING
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51455-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-655-3242
Provider Business Practice Location Address Fax Number:
712-655-2871
Provider Enumeration Date:
09/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PODEY
Authorized Official First Name:
LUCAS
Authorized Official Middle Name:
FREDERICK
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
712-655-3242

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  007368 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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