1003038241 NPI number — GARNETT CHIROPRACTIC & REHAB CENTER, PA

Table of content: (NPI 1003038241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003038241 NPI number — GARNETT CHIROPRACTIC & REHAB CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GARNETT CHIROPRACTIC & REHAB CENTER, PA
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:
1003038241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
876 SELBY AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST. PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-225-4421
Provider Business Mailing Address Fax Number:
651-222-4672

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
876 SELBY AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-225-4421
Provider Business Practice Location Address Fax Number:
651-222-4672
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARNETT
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
651-225-4421

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  4384 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 658052 . This is a "CHIROCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 404L6GA . This is a "MN BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com