1699004192 NPI number — CHRISTOPHER TERENCE CHECKETT LISW

Table of content: CHRISTOPHER TERENCE CHECKETT LISW (NPI 1699004192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699004192 NPI number — CHRISTOPHER TERENCE CHECKETT LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHECKETT
Provider First Name:
CHRISTOPHER
Provider Middle Name:
TERENCE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
M

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:
1699004192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20325 CENTER RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 628
Provider Business Mailing Address City Name:
ROCKY RIVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44116-3572
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-331-5570
Provider Business Mailing Address Fax Number:
440-331-3221

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20325 CENTER RIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 628
Provider Business Practice Location Address City Name:
ROCKY RIVER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44116-3572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-331-5570
Provider Business Practice Location Address Fax Number:
440-331-3221
Provider Enumeration Date:
12/11/2009

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: 1041C0700X , with the licence number:  I0800032 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com