1427284637 NPI number — HENNICKEN FAMILY CHIROPRACTIC

Table of content: (NPI 1427284637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427284637 NPI number — HENNICKEN FAMILY CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HENNICKEN FAMILY CHIROPRACTIC
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:
1427284637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 GLOBAL DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29607-4628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-644-2700
Provider Business Mailing Address Fax Number:
864-644-2709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1624 WOODRUFF RD
Provider Second Line Business Practice Location Address:
STE. 8
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29607-5976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-363-5239
Provider Business Practice Location Address Fax Number:
864-281-1555
Provider Enumeration Date:
06/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HENNICKEN
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
864-363-5239

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3322 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3322 . This is a "DC LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com