1922021575 NPI number — RODRICK C. HAHN D.C.

Table of content: DR. GINA M DELUCCA PHARMD (NPI 1114090529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922021575 NPI number — RODRICK C. HAHN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAHN
Provider First Name:
RODRICK
Provider Middle Name:
C.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1922021575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1679 OLD PRESTON HWY N
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40229-3297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-957-1021
Provider Business Mailing Address Fax Number:
502-957-1703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1679 OLD PRESTON HWY N
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40229-3297
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-957-1021
Provider Business Practice Location Address Fax Number:
502-957-1703
Provider Enumeration Date:
07/25/2006

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:  4365 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 244548000-2445427000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000041631 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 5674124 . This is a "CIGNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85002988 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00154881 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 44-00228 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 2426754 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: DC2130 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50004038-50004037 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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