1366611378 NPI number — S AND S UNITED 'LLC'

Table of content: (NPI 1366611378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366611378 NPI number — S AND S UNITED 'LLC'

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
S AND S UNITED '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:
AMERICAN CHIROPRACTIC AND SPINAL DECOMPRESSION CENTER
Provider Other Organization Name Type Code:
3
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:
1366611378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4869 PALM COAST PKWY NW
Provider Second Line Business Mailing Address:
SUITE #1
Provider Business Mailing Address City Name:
PALM COAST
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32137-3661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-597-4915
Provider Business Mailing Address Fax Number:
386-597-4953

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4869 PALM COAST PKWY NW
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
PALM COAST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32137-3661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-597-4915
Provider Business Practice Location Address Fax Number:
386-597-4953
Provider Enumeration Date:
02/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SERGENT
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
MGR
Authorized Official Telephone Number:
386-597-4915

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH 9393 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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