1376690750 NPI number — DR. BRANDON WILLIAM BIRD D.C.

Table of content: DR. BRANDON WILLIAM BIRD D.C. (NPI 1376690750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376690750 NPI number — DR. BRANDON WILLIAM BIRD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRD
Provider First Name:
BRANDON
Provider Middle Name:
WILLIAM
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:
1376690750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 WHITE HORSE RD
Provider Second Line Business Mailing Address:
BUILDING B STE 200
Provider Business Mailing Address City Name:
VOORHEES
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08043-2119
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-783-6789
Provider Business Mailing Address Fax Number:
856-783-7199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 WHITE HORSE RD
Provider Second Line Business Practice Location Address:
BUILDING B SUITE 200
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-2119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-783-6789
Provider Business Practice Location Address Fax Number:
856-783-7199
Provider Enumeration Date:
01/05/2007

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:  38MC00606300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: DC009084 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 113676280 . This is a "HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 113676280 . This is a "CARPENTERS HEALTH AND WEL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 113676280 . This is a "ALLSTATE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2212354000 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 665240 . This is a "ACN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 0062766 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113676280 . This is a "ATLANTICARE ADMINISTRATOR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 113676280 . This is a "CONCENTRA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 113676280 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 066247 . This is a "APWU HEALTH PLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3020655 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 665240 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2212354000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2213023000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3020655 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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