1104028265 NPI number — AMA CHIROPRACTIC ALTERNATIVE SERVICES PC

Table of content: (NPI 1104028265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104028265 NPI number — AMA CHIROPRACTIC ALTERNATIVE SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMA CHIROPRACTIC ALTERNATIVE SERVICES PC
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:
1104028265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 COBBLESTONE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN CARBON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62034-1496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-288-7518
Provider Business Mailing Address Fax Number:
618-692-9772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 SOUTH FILLMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-692-9763
Provider Business Practice Location Address Fax Number:
618-692-9772
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MUHIUDDIN
Authorized Official First Name:
FAROOK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
618-288-7518

Provider Taxonomy Codes

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

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

  • Identifier: 7233470 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5675679 . This is a "FIRST HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 672256 . This is a "UHC" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 719909 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 202370 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: POO264483 . This is a "RRMEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 9516006 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 06032164 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com