1073696803 NPI number — DR. JAMES D. SPERTZEL

Table of content: ANNA P. NADHAN MD (NPI 1083149660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073696803 NPI number — DR. JAMES D. SPERTZEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JAMES D. SPERTZEL
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:
CHIROPRACTIC FITNESS CLINIC
Provider Other Organization Name Type Code:
5
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:
1073696803
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 NORTH MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIGLERVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17307-9228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-677-6036
Provider Business Mailing Address Fax Number:
717-677-9503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIGLERVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17307-9228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-677-6036
Provider Business Practice Location Address Fax Number:
717-677-9503
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPERTZEL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-677-6036

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC002642L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01824401 . This is a "BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 441667 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com