1245520717 NPI number — JK2C, LLC

Table of content: HANNAH DALY ATC, LAT (NPI 1457845489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245520717 NPI number — JK2C, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JK2C, LLC
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:
6
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:
1245520717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6105 KENT CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23435-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-774-0033
Provider Business Mailing Address Fax Number:
757-394-3094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 WIMBLEDON SQ
Provider Second Line Business Practice Location Address:
UNIT H
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-774-0033
Provider Business Practice Location Address Fax Number:
757-394-3094
Provider Enumeration Date:
04/18/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHINNICI
Authorized Official First Name:
KERI
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
757-774-0033

Provider Taxonomy Codes

  • Taxonomy code: 261QM2800X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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