1902108467 NPI number — MONROE SPORTS AND FAMILY CHIROPRACTIC,INC

Table of content: (NPI 1902108467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902108467 NPI number — MONROE SPORTS AND FAMILY CHIROPRACTIC,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE SPORTS AND FAMILY CHIROPRACTIC,INC
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:
ALCOVY SPORTS AND FAMILY CHIROPRACTIC
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:
1902108467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1658
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30655-6658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-207-5454
Provider Business Mailing Address Fax Number:
770-207-9465

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
311 ALCOVY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30655-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-207-5454
Provider Business Practice Location Address Fax Number:
770-207-9465
Provider Enumeration Date:
12/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCHRAUB
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
770-207-5454

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  CHIR006524 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com