1730368861 NPI number — BULL CHIROPRACTIC WOODBURN

Table of content: (NPI 1730368861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730368861 NPI number — BULL CHIROPRACTIC WOODBURN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BULL CHIROPRACTIC WOODBURN
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:
1730368861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7910 COLDWATER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46825-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-489-3636
Provider Business Mailing Address Fax Number:
260-489-3611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4325 COLLEGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBURN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
260-632-4244
Provider Business Practice Location Address Fax Number:
260-632-5141
Provider Enumeration Date:
10/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORR
Authorized Official First Name:
MARY
Authorized Official Middle Name:
KATHRYN (KATIE)
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
260-489-3636

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08001415A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 383841 . This is a "ANTHEM PIN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com