1487650131 NPI number — JRH CHIROPRACTIC SERVICES INC

Table of content: (NPI 1487650131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487650131 NPI number — JRH CHIROPRACTIC SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JRH CHIROPRACTIC SERVICES INC
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:
1487650131
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2620 MEMORIAL BLVD
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
CONNELLSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15425-1488
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-626-8890
Provider Business Mailing Address Fax Number:
724-626-2983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
STE E
Provider Business Practice Location Address City Name:
CONNELLSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15425-1488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-626-8890
Provider Business Practice Location Address Fax Number:
724-626-2983
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HURLEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
RAYMOND
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-626-8890

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC004033L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0004542737 . This is a "AETNA INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 62156 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012691440002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1500256 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 415912 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011633880002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 309990 . This is a "UPMC INSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: JR711503 . This is a "GROUP NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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