1861483745 NPI number — DR. THOMAS ARTHUR DUNLAP JR. DC

Table of content: LISA J HENRY LMSW (NPI 1801051396)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861483745 NPI number — DR. THOMAS ARTHUR DUNLAP JR. DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNLAP
Provider First Name:
THOMAS
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
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:
1861483745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 N RANGE LINE RD
Provider Second Line Business Mailing Address:
#6
Provider Business Mailing Address City Name:
JOPLIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64801-1602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-624-1276
Provider Business Mailing Address Fax Number:
417-624-7513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 N RANGE LINE RD
Provider Second Line Business Practice Location Address:
#6
Provider Business Practice Location Address City Name:
JOPLIN
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64801-1602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-624-1276
Provider Business Practice Location Address Fax Number:
417-624-7513
Provider Enumeration Date:
10/31/2005

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:  5278 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 752700609 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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