1497876320 NPI number — NEWPORT CHIROPRACTIC HEALTH CENTER

Table of content: (NPI 1497876320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497876320 NPI number — NEWPORT CHIROPRACTIC HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWPORT CHIROPRACTIC HEALTH CENTER
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:
1497876320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 367
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04953-0367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-368-4318
Provider Business Mailing Address Fax Number:
207-368-5224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE S
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04953-4157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-368-4318
Provider Business Practice Location Address Fax Number:
207-368-5224
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAULTER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER S CORPORATION
Authorized Official Telephone Number:
207-368-4318

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CR880 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10903690 . This is a "CAQH PROVIDER NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 015712 . This is a "ANTHEM BC BS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: CM2240 . This is a "RR MEDICARE GROUP ID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M22331 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1042422 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: MNT164 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 0000418 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 129380000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350029711 . This is a "RR MEDICARE, PALMETTO GBA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com