1306827118 NPI number — WILDWOOD CHIROPRACTIC CENTER PA

Table of content: (NPI 1306827118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306827118 NPI number — WILDWOOD CHIROPRACTIC CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILDWOOD CHIROPRACTIC CENTER PA
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:
1306827118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 WILDWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE BEAR LAKE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55115-1847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-779-4263
Provider Business Mailing Address Fax Number:
651-779-4274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 WILDWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE BEAR LAKE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55115-1847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-779-4263
Provider Business Practice Location Address Fax Number:
651-779-4274
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
NAPOLI
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
GERARD
Authorized Official Title or Position:
OWNER DR OF CHIROPRACTIC
Authorized Official Telephone Number:
651-779-4263

Provider Taxonomy Codes

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

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

  • Identifier: 4261 . This is a "JOHN MACK LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 047 828 800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3150 . This is a "SCOTT DEPAULIS LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 354 278 500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 367 817 200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 549 027 800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2329 . This is a "PATRICK G NAPOLI LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 3051 . This is a "DEAN JOY LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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