1720102767 NPI number — DR. JOEL D MULLINS DC

Table of content: DR. JOEL D MULLINS DC (NPI 1720102767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720102767 NPI number — DR. JOEL D MULLINS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLINS
Provider First Name:
JOEL
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1720102767
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 MILL RD UNIT K
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03824-3047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-953-3602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 MILL RD UNIT K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03824-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-953-3602
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2007

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:  764-0506 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05Y010680NH01 . This is a "BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 9173104 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 50Y984500NH01 . This is a "BLUE SHIELD" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".