1982894945 NPI number — PAMER FAMILY CHIROPRACTIC, LLC

Table of content: (NPI 1982894945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982894945 NPI number — PAMER FAMILY CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMER FAMILY 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:
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:
1982894945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
246 W OLENTANGY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POWELL
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43065-8434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-798-1419
Provider Business Mailing Address Fax Number:
614-798-1430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
246 W OLENTANGY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWELL
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43065-8434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-798-1419
Provider Business Practice Location Address Fax Number:
614-798-1430
Provider Enumeration Date:
07/26/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAMER
Authorized Official First Name:
MACKENZIE
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
614-798-1419

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2868 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2257249 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".