1114052115 NPI number — DR. JONATHAN HOWARD VAHUE D.C.

Table of content: DR. JONATHAN HOWARD VAHUE D.C. (NPI 1114052115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114052115 NPI number — DR. JONATHAN HOWARD VAHUE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAHUE
Provider First Name:
JONATHAN
Provider Middle Name:
HOWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1114052115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3234 S WESTNEDGE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49008-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
269-567-4111
Provider Business Mailing Address Fax Number:
269-567-4113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3234 S WESTNEDGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49008-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-567-4111
Provider Business Practice Location Address Fax Number:
269-567-4113
Provider Enumeration Date:
02/22/2007

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:  2301007884 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1114052115 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1629103528 . This is a "GROUP NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0P02900 . This is a "MEDICARE GROUP PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 950C91206 . This is a "BLUE CROSS BLUE SHIELD PIN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P2900001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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