1790912418 NPI number — DR. JOEL NOLAND N.D., LAC

Table of content: MR. DANIEL D BOLTON M.A., LMHC (NPI 1699819565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790912418 NPI number — DR. JOEL NOLAND N.D., LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLAND
Provider First Name:
JOEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
N.D., LAC
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:
1790912418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1834 W BURBANK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURBANK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91506-1348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-736-9889
Provider Business Mailing Address Fax Number:
800-830-0421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1834 W BURBANK BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURBANK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91506-1348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-736-9889
Provider Business Practice Location Address Fax Number:
800-830-0421
Provider Enumeration Date:
06/20/2009

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: 225700000X , with the licence number:  MA0023988 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: NT60186072 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: ND-432 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: AC-14280 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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