1023187440 NPI number — DR. JOSEPH MICHAEL BANGERT JR. D.C.

Table of content: DR. JOSEPH MICHAEL BANGERT JR. D.C. (NPI 1023187440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023187440 NPI number — DR. JOSEPH MICHAEL BANGERT JR. D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANGERT
Provider First Name:
JOSEPH
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.C.
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:
1023187440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29732-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-366-4143
Provider Business Mailing Address Fax Number:
803-366-4530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4214 OLD YORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732-9179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-366-4143
Provider Business Practice Location Address Fax Number:
803-366-4530
Provider Enumeration Date:
11/07/2006

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:  1014 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com