1164573754 NPI number — KEMP CHIROPRACTIC, P.A.

Table of content: (NPI 1164573754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164573754 NPI number — KEMP CHIROPRACTIC, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEMP CHIROPRACTIC, P.A.
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:
1164573754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4169 UNIVERSITY BLVD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-737-2350
Provider Business Mailing Address Fax Number:
904-737-7111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4169 UNIVERSITY BLVD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32216-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-737-2350
Provider Business Practice Location Address Fax Number:
904-737-7111
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KEMP
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-737-2350

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00001534 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: CH00007780 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NN0400X , with the licence number: CH00007780 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 72157 . This is a "GROUP#BLUE CROSS BLSHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: POO293084 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 89282 . This is a "BLUE CROSS BLUE SHIELD(F)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 89940 . This is a "BLUE CROSS BLUE SHIELD(D)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DE4435 . This is a "RAILROAD MEDICARE GROUP#" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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