1538215462 NPI number — VIRGA CHIROPRACTIC CLINIC PA

Table of content: DR. LUIS RONALD PERNIA M.D. (NPI 1174504336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538215462 NPI number — VIRGA CHIROPRACTIC CLINIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGA CHIROPRACTIC CLINIC PA
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:
1538215462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12670 LAKE BLVD PO BOX 482
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDSTROM
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55045-0482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-257-1000
Provider Business Mailing Address Fax Number:
651-257-1020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12670 LAKE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDSTROM
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55045-0482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-257-1000
Provider Business Practice Location Address Fax Number:
651-257-1020
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VIRGA
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
651-257-1000

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2686 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 2700 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 202790900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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