1295778488 NPI number — DR. RICHARD G HABIGHORST D.C.

Table of content: DR. RICHARD G HABIGHORST D.C. (NPI 1295778488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295778488 NPI number — DR. RICHARD G HABIGHORST D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HABIGHORST
Provider First Name:
RICHARD
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1295778488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1981 MIDWAY RD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MENASHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54952-7001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-882-7292
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1981 MIDWAY RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MENASHA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54952-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-882-7292
Provider Business Practice Location Address Fax Number:
920-882-8973
Provider Enumeration Date:
06/14/2006

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:  1288 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38824900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391451676012 . This is a "BLUECROSS & BLUESHEILD" identifier . This identifiers is of the category "OTHER".




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