1578740940 NPI number — BYRNE CHIROPRACTIC, INC.

Table of content: (NPI 1578740940)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578740940 NPI number — BYRNE CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYRNE CHIROPRACTIC, 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:
1578740940
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PETRO PL STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIRARD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44420-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-545-8170
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PETRO PL STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIRARD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44420-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-545-8170
Provider Business Practice Location Address Fax Number:
330-545-5917
Provider Enumeration Date:
01/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BYRNE
Authorized Official First Name:
GORDON
Authorized Official Middle Name:
BRIAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-545-8170

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0315673 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000182895 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04270058300 . This is a "BWC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 042700583001 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2058393 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2576 . This is a "STATE OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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