1932102274 NPI number — DR. JOSEPH DISPENZA D.C.

Table of content: DR. JOSEPH DISPENZA D.C. (NPI 1932102274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932102274 NPI number — DR. JOSEPH DISPENZA D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DISPENZA
Provider First Name:
JOSEPH
Provider Middle Name:
Provider Name Prefix Text:
DR.
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:
DISPENZA
Provider Other First Name:
JOE
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1932102274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAINIER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98576-0656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-400-3151
Provider Business Mailing Address Fax Number:
360-400-3150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 1ST ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YELM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98597-7634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-400-3151
Provider Business Practice Location Address Fax Number:
360-400-3150
Provider Enumeration Date:
05/31/2005

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:  025202CH00002150 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00286072 . This is a "RAILROAD MEDICARE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 330154719 . This is a "FEDERAL CLINC TAX ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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