1003964727 NPI number — DR. KRISTI DILLON DC

Table of content: DR. KRISTI DILLON DC (NPI 1003964727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003964727 NPI number — DR. KRISTI DILLON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DILLON
Provider First Name:
KRISTI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1003964727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
87B OMEGA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-733-0980
Provider Business Mailing Address Fax Number:
302-733-7495

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
87B OMEGA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19713-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-733-0980
Provider Business Practice Location Address Fax Number:
302-733-7495
Provider Enumeration Date:
01/08/2007

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: 111NR0400X , with the licence number:  F1-0000439 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 293740 . This is a "MIAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0319694000 . This is a "AMERIHEATLH HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 648555 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1654166 . This is a "CIGNA PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 872494 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 386606CHI . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 52921 . This is a "COVENTRY" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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