1871527895 NPI number — GOBBIE CHIROPRACTIC CENTER

Table of content: (NPI 1871527895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871527895 NPI number — GOBBIE CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOBBIE CHIROPRACTIC CENTER
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:
1871527895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 WATERDAM PLAZA DR STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MC MURRAY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15317-5411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-969-4242
Provider Business Mailing Address Fax Number:
724-969-4244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 E MCMURRAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC MURRAY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15317-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-969-4242
Provider Business Practice Location Address Fax Number:
724-969-4244
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOBBIE
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-969-4242

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC-007028-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01915544 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 217097 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2108975000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0069030001 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1600527 . This is a "BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".