1194919282 NPI number — EXCELSIOR CHIROPRACTIC CENTER, PC

Table of content: (NPI 1194919282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194919282 NPI number — EXCELSIOR CHIROPRACTIC CENTER, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCELSIOR CHIROPRACTIC CENTER, PC
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:
1194919282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 N JESSE JAMES RD STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EXCELSIOR SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64024-1244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-620-6211
Provider Business Mailing Address Fax Number:
816-630-6211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 N JESSE JAMES RD STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EXCELSIOR SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64024-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-620-6211
Provider Business Practice Location Address Fax Number:
816-630-6211
Provider Enumeration Date:
08/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY
Authorized Official First Name:
INA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
816-620-6211

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  005147 , 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: 12330037 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4412828 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2032917 . This is a "CIGNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 4400182 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: T73784 . This is a "HUMANA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: T78406 . This is a "UPIN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 532434 . This is a "BCBS KS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00058846 . This is a "RRMEDC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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