1578769345 NPI number — ADVANCED CHIROPRACTIC HEALTH

Table of content: (NPI 1578769345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578769345 NPI number — ADVANCED CHIROPRACTIC HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED CHIROPRACTIC HEALTH
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:
1578769345
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:
1402 NW VIVION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64118-4555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-746-9045
Provider Business Mailing Address Fax Number:
816-746-9032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1402 NW VIVION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64118-4555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-746-9045
Provider Business Practice Location Address Fax Number:
816-746-9032
Provider Enumeration Date:
06/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCNERNEY
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-746-9045

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2000167943 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00491248 . This is a "MISSOURI CORPORATE NO." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1386852127 . This is a "TYPE 1 NPI" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 18104711 . This is a "MISSOURI STATE TAX ID" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 29808015 . This is a "BC BS INDIVIDUAL DR. NO." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2000167943 . This is a "STATE LICENSE NO." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 09803014 . This is a "BC BS GROUP NO." identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DE 870005 . This is a "EMPLOYER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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