1538372933 NPI number — FIRST DC HOLISTIC MEDICAL CENTRE

Table of content: (NPI 1538372933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538372933 NPI number — FIRST DC HOLISTIC MEDICAL CENTRE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST DC HOLISTIC MEDICAL CENTRE
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:
LAVANGA CHIROPRACTIC
Provider Other Organization Name Type Code:
4
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:
1538372933
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:
112 E PENNSYLVANIA BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FEASTERVILLE TREVOSE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19053-7843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-364-1112
Provider Business Mailing Address Fax Number:
215-364-3231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 E PENNSYLVANIA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEASTERVILLE TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-7843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-364-1112
Provider Business Practice Location Address Fax Number:
215-364-3231
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAVANGA
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
FRANK
Authorized Official Title or Position:
CHIROPRACTOR OWNER
Authorized Official Telephone Number:
215-364-1112

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC003377L , 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: 1038026 . This is a "ASHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2823869 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5017555 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CAQH . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 663095 . This is a "ACN GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: N90763 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1390763 . This is a "HIGHMARK BLUESHEILD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 381023 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 4924929 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2080174000 . This is a "PERSONAL CHOICE KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3685273 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 740993 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com