1053553271 NPI number — DR. NECOLE LARUE CHIROPRACTOR INC.

Table of content: (NPI 1053553271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053553271 NPI number — DR. NECOLE LARUE CHIROPRACTOR INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. NECOLE LARUE CHIROPRACTOR INC.
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:
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:
1053553271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 E WASHINGTON ST
Provider Second Line Business Mailing Address:
UNIT 14
Provider Business Mailing Address City Name:
NORTH ATTLEBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02760-6301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-643-7050
Provider Business Mailing Address Fax Number:
505-643-9619

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
UNIT 14
Provider Business Practice Location Address City Name:
NORTH ATTLEBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02760-6301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-643-7050
Provider Business Practice Location Address Fax Number:
505-643-9619
Provider Enumeration Date:
04/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LARUE
Authorized Official First Name:
NECOLE
Authorized Official Middle Name:
LILLIAN
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
508-643-7050

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2159 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 20585541 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 29065 . This is a "BLUE CROSS BLUE SHIELD RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 401416 . This is a "BLUE CROSS BLUE SHIELD RI BL;UE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: Y36507 . This is a "BLUE CROSS BLUE SHIELD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1610732 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: B20808501 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 4400505 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 351208 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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