1134137268 NPI number — DR. ALLISON WOLAK QUADHAMER D.C.

Table of content: DR. ALLISON WOLAK QUADHAMER D.C. (NPI 1134137268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134137268 NPI number — DR. ALLISON WOLAK QUADHAMER D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUADHAMER
Provider First Name:
ALLISON
Provider Middle Name:
WOLAK
Provider Name Prefix Text:
DR.
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:
WOLAK
Provider Other First Name:
ALLISON
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134137268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
383 BIG PINE DR.
Provider Second Line Business Mailing Address:
PO BOX 335
Provider Business Mailing Address City Name:
WEST LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-607-4671
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 HIGHWAY 34
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UTICA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68456-6079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-534-2203
Provider Business Practice Location Address Fax Number:
402-534-2204
Provider Enumeration Date:
08/04/2006

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:  038010513 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 1562 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 08002929A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1L0100 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5782014 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 110621 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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