1720095839 NPI number — NICK GEORGE KOINOGLOU D.C., FIAMA, DIPL AC

Table of content: STEPHEN ANTHONY DUNNINGS (NPI 1093314411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720095839 NPI number — NICK GEORGE KOINOGLOU D.C., FIAMA, DIPL AC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOINOGLOU
Provider First Name:
NICK
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C., FIAMA, DIPL AC
Provider Gender Code:
M

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:
1720095839
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2565 S UNION AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLIANCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44601-5058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-821-4455
Provider Business Mailing Address Fax Number:
330-821-4504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2565 S UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44601-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-821-4455
Provider Business Practice Location Address Fax Number:
330-821-4504
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1798 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 34179785200 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2364409 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4643272 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 733297 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000176741 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0886297 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341797852T . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IDP1817694 . This is a "OXFORD HEALTH PLAN ID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1066011 . This is a "WORKER'S COMP PIN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000000139080 . This is a "BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 721624 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 721624 . This is a "BC OF WESTERN PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 341797852027 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350050794 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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