1174953699 NPI number — COVERED BRIDGES CHIROPRACTIC PLLC

Table of content: (NPI 1174953699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174953699 NPI number — COVERED BRIDGES CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COVERED BRIDGES CHIROPRACTIC PLLC
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:
1174953699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 N 2ND AVE
Provider Second Line Business Mailing Address:
UNIT 1
Provider Business Mailing Address City Name:
WINTERSET
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50273-1601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-978-1189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N 2ND AVE
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
WINTERSET
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50273-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-978-1189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ASHMAN
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
LYLE
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
515-978-1189

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  007223 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com