1174903322 NPI number — SIMON NOLTING

Table of content: SIMON NOLTING (NPI 1174903322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174903322 NPI number — SIMON NOLTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOLTING
Provider First Name:
SIMON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NOLTING
Provider Other First Name:
SIMON
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1174903322
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2404 STATE HIGHWAY 248 STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65616-9627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-336-5856
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2404 STATE HIGHWAY 248 STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65616-9627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-336-5856
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2015

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:  2015013966 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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