1992883870 NPI number — DAVID JAMES KREPS DC

Table of content: DAVID JAMES KREPS DC (NPI 1992883870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992883870 NPI number — DAVID JAMES KREPS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KREPS
Provider First Name:
DAVID
Provider Middle Name:
JAMES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1992883870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1275
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORHEAD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56561-1275
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-236-1187
Provider Business Mailing Address Fax Number:
218-236-8514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1675 HIGHWAY 10 WEST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DILWORTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56529-1346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-236-1187
Provider Business Practice Location Address Fax Number:
218-236-8514
Provider Enumeration Date:
11/01/2006

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:  2116 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 346 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 488 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 61292KR . This is a "BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 411511678 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350038504 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 357027400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4482948 . This is a "MEDICA ACN CHIROPRACTIC C" identifier . This identifiers is of the category "OTHER".
  • Identifier: 85934KR . This is a "BCBS MN BLUE PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10554 . This is a "BCBS ND" identifier . This identifiers is of the category "OTHER".