1881779031 NPI number — ADVANCED BACK SOLUTIONS

Table of content: (NPI 1881779031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881779031 NPI number — ADVANCED BACK SOLUTIONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED BACK SOLUTIONS
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:
PLYMOUTH CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
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:
1881779031
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
615 N MILL ST
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
PLYMOUTH
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48170-1397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-437-7689
Provider Business Mailing Address Fax Number:
734-437-7699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 N MILL ST
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48170-1397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-437-7689
Provider Business Practice Location Address Fax Number:
734-437-7699
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VENERUS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
734-437-7689

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301008605 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1871529404 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0H22911 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 144951428 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com