1356495378 NPI number — WEST MOBILE CHIROPRACTIC P.C.

Table of content: (NPI 1356495378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356495378 NPI number — WEST MOBILE CHIROPRACTIC P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST MOBILE CHIROPRACTIC P.C.
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:
1356495378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 CODY RD S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36695-3408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-344-8588
Provider Business Mailing Address Fax Number:
251-344-8985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
260 CODY RD S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36695-3408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-344-8588
Provider Business Practice Location Address Fax Number:
251-344-8985
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNGBLOOD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
251-344-8588

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1101 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 4410063 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 14767 . This is a "PRINCIPAL HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 4664879 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51070922 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: T68625 . This is a "VIVA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 770616 . This is a "FIRST HEALTH" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 388534 . This is a "CCN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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