1144374414 NPI number — GILES CHIROPRACTIC CLINIC PC

Table of content: (NPI 1144374414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144374414 NPI number — GILES CHIROPRACTIC CLINIC PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GILES CHIROPRACTIC CLINIC 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:
1144374414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
514 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NARROWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24124-1321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-726-2318
Provider Business Mailing Address Fax Number:
540-726-7665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NARROWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24124-1321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-726-2318
Provider Business Practice Location Address Fax Number:
540-726-7665
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RAWNSLEY
Authorized Official First Name:
STEWART
Authorized Official Middle Name:
MELVILLE
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
540-726-2318

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  0104000570 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009502221 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 263805 . This is a "MAMSI #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 049852 . This is a "ANTHEM PROVIDER #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1134123482 . This is a "NPI #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0131172000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4558326 . This is a "AETNA #" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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