1598843609 NPI number — DR. JULIE LYN DEAN DC, DICCP

Table of content: DR. JULIE LYN DEAN DC, DICCP (NPI 1598843609)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598843609 NPI number — DR. JULIE LYN DEAN DC, DICCP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEAN
Provider First Name:
JULIE
Provider Middle Name:
LYN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, DICCP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEAN-MCCURDY
Provider Other First Name:
JULIE
Provider Other Middle Name:
LYN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC, DICCP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1598843609
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3325 AVENUE OF THE CITIES
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-4304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-757-8510
Provider Business Mailing Address Fax Number:
309-757-8516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3325 AVENUE OF THE CITIES
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-4304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-757-8510
Provider Business Practice Location Address Fax Number:
309-757-8516
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  038-007999 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 35-0051879 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8127241 . This is a "BLUE SHIELD ID NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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