1922312800 NPI number — THOMAS H. GREEN CHIROPRACTIC, LLC

Table of content: MANUEL ALEJANDRO ACOSTA HERNANDEZ DDS (NPI 1619523560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922312800 NPI number — THOMAS H. GREEN CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS H. GREEN CHIROPRACTIC, 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:
6
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:
1922312800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1134 W MAPLEWOOD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65807-4763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-522-9395
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8800 W STATE HIGHWAY 86
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELL KNOB
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65747-9176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-858-8818
Provider Business Practice Location Address Fax Number:
417-858-8819
Provider Enumeration Date:
08/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
417-858-8818

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 005235 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 756208302 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com