1063507689 NPI number — MRS. TRICIA KEELAN LECHMAIER D.C.

Table of content: MRS. TRICIA KEELAN LECHMAIER D.C. (NPI 1063507689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063507689 NPI number — MRS. TRICIA KEELAN LECHMAIER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LECHMAIER
Provider First Name:
TRICIA
Provider Middle Name:
KEELAN
Provider Name Prefix Text:
MRS.
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:
LECHMAIER
Provider Other First Name:
CHRISTOPHER
Provider Other Middle Name:
JOHN
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063507689
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:
852-35 SAXON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32763-8211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-775-3600
Provider Business Mailing Address Fax Number:
386-775-3602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
852-35 SAXON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32763-8211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-775-3600
Provider Business Practice Location Address Fax Number:
386-775-3602
Provider Enumeration Date:
10/03/2006

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: 111N00000X , with the licence number:  CH8504 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89068 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 010392000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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