1164613865 NPI number — DAWN M ROBINSON CHIROPRACTIC SC

Table of content: (NPI 1164613865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164613865 NPI number — DAWN M ROBINSON CHIROPRACTIC SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN M ROBINSON CHIROPRACTIC SC
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:
1164613865
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 LINCOLN PLACE CT
Provider Second Line Business Mailing Address:
STE 103
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-277-3575
Provider Business Mailing Address Fax Number:
618-277-6679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 LINCOLN PLACE CT
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-277-3575
Provider Business Practice Location Address Fax Number:
618-277-6679
Provider Enumeration Date:
08/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
618-277-3575

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038008946 , 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: 08227028 . This is a "BCBS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4400091 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 627842 . This is a "ACN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 426689 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1156684 . This is a "FIRST HEALTH MAIL HANDLER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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