1366633323 NPI number — CASSITY CHIROPRACTIC CENTER LLC

Table of content: DR. RAHUL JANDIAL M.D., PH.D. (NPI 1417108358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366633323 NPI number — CASSITY CHIROPRACTIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASSITY CHIROPRACTIC CENTER 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:
1366633323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2111 WILDWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49202-4048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-787-8309
Provider Business Mailing Address Fax Number:
517-787-8409

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 WILDWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49202-4048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-787-8309
Provider Business Practice Location Address Fax Number:
517-787-8409
Provider Enumeration Date:
08/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASSITY
Authorized Official First Name:
GLORIA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OFFICE MANAGER, CHIROPRACTIC ASS.
Authorized Official Telephone Number:
517-787-8309

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301008940 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OP24270001 . This is a "MEDICARE PLUS BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com