1083952915 NPI number — RONALD WILCOX, DC INC.

Table of content: DR. NICOLAS PATRICK GOLDSTEIN NOVICK MD, PHD (NPI 1578186805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083952915 NPI number — RONALD WILCOX, DC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RONALD WILCOX, DC 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:
6
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:
1083952915
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 PINEHURST DR SW
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
TUMWATER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-352-8112
Provider Business Mailing Address Fax Number:
360-352-8113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
204 PINEHURST DR SW
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
TUMWATER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98501-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-352-8112
Provider Business Practice Location Address Fax Number:
360-352-8113
Provider Enumeration Date:
01/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WILCOX
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-352-8112

Provider Taxonomy Codes

  • Taxonomy code: 111NX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G001002046 . This is a "MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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