1053490706 NPI number — DR. ELIZABETH ANNE BARTLETT D.C.

Table of content: ALISON KLUK MED (NPI 1255857488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053490706 NPI number — DR. ELIZABETH ANNE BARTLETT D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTLETT
Provider First Name:
ELIZABETH
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1053490706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
199 DIAMOND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRAWFORDSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47933-8320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-699-5714
Provider Business Mailing Address Fax Number:
630-473-2477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
953 MONUMENT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46052-2968
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-699-5714
Provider Business Practice Location Address Fax Number:
630-473-2477
Provider Enumeration Date:
11/03/2006

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: 111NI0900X , with the licence number:  038-009605 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NI0900X , with the licence number: 08003268A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7957448 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 02232594 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 3610727 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 11562742 . This is a "CAQH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 697284 . This is a "ACN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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