1942547229 NPI number — SYCAMORE INTEGRATED HEALTH, LTD

Table of content: (NPI 1942547229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942547229 NPI number — SYCAMORE INTEGRATED HEALTH, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYCAMORE INTEGRATED HEALTH, LTD
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:
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:
1942547229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 W PRAIRIE DR STE J
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYCAMORE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60178-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-895-3354
Provider Business Mailing Address Fax Number:
815-895-3345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 W PRAIRIE DR STE J
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYCAMORE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60178-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-895-3354
Provider Business Practice Location Address Fax Number:
815-895-3345
Provider Enumeration Date:
01/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEDY
Authorized Official First Name:
ZACHARY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/ CHIROPRACTOR
Authorized Official Telephone Number:
815-895-3354

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038011487 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 038011487 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 038011487 . This is a "PROVIDER LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 38011552 . This is a "PROVIDER LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 209019770 . This is a "PROVIDER LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 038011552 . This is a "PROVIDER LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 038013537 . This is a "PROVIDER LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 038013632 . This is a "PROVIDER LICENSE NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com