1871535591 NPI number — HEDMAN CHIROPRACTIC CENTER LLC

Table of content: (NPI 1871535591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871535591 NPI number — HEDMAN CHIROPRACTIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEDMAN CHIROPRACTIC CENTER LLC
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:
1871535591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDOM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56101-1658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-831-4770
Provider Business Mailing Address Fax Number:
507-831-2077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDOM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56101-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-831-4770
Provider Business Practice Location Address Fax Number:
507-831-2077
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEDMAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
GOVERNOR
Authorized Official Telephone Number:
507-831-4770

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  003255 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10156 . This is a "CCMI" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 22049 . This is a "SIOUX VALLEY HEALTH PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 563327300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 411508205 . This is a "HEALTH SERVICES MGMT, INC" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 231970 . This is a "U CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1016365 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4C694HE . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com