1568661080 NPI number — WINCHESTER CHIROPRACTIC, P.C.

Table of content: (NPI 1568661080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568661080 NPI number — WINCHESTER CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINCHESTER CHIROPRACTIC, P.C.
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:
1568661080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 WALTER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOSCOW MILLS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63362-1197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-356-5557
Provider Business Mailing Address Fax Number:
636-356-5558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 WALTER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSCOW MILLS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63362-1197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-356-5557
Provider Business Practice Location Address Fax Number:
636-356-5558
Provider Enumeration Date:
07/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HILGEFORT
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MANAGER
Authorized Official Telephone Number:
636-356-5557

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2003011597 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NS0005X , with the licence number: 2004010186 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 653134 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 471354 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 665379 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: V03758 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 551715 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 713979 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7171684 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 7368716 . This is a "AETNA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1255473864 . This is a "NPI FOR DR. WINCHESTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1326180951 . This is a "NIP DR. HILGEFORT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 195807 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: U96934 . This is a "MERCY" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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