1194840173 NPI number — DR. DEBORAH ANN BLAIN CHIROPRACTOR

Table of content: DR. DEBORAH ANN BLAIN CHIROPRACTOR (NPI 1194840173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194840173 NPI number — DR. DEBORAH ANN BLAIN CHIROPRACTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAIN
Provider First Name:
DEBORAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
CHIROPRACTOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THRIFT
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194840173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1621 TOWNE DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65202-3654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-474-8800
Provider Business Mailing Address Fax Number:
573-474-8088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1621 TOWNE DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65202-3654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-474-8800
Provider Business Practice Location Address Fax Number:
573-474-8088
Provider Enumeration Date:
03/20/2007

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:  004102 , 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)

  • Identifier: 4409000 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000000471379 . This is a "BLUE CROSS AND BLUE SHIE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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