1700958014 NPI number — CHIROPRACTIC HEALTH CENTER OF GARNER PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700958014 NPI number — CHIROPRACTIC HEALTH CENTER OF GARNER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHIROPRACTIC HEALTH CENTER OF GARNER PA
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:
1700958014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 UMSTEAD LN.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-3099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-779-2424
Provider Business Mailing Address Fax Number:
919-779-5235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
708 UMSTEAD LN.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARNER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27529-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-779-2424
Provider Business Practice Location Address Fax Number:
919-779-5235
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SAUNDERS
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
EILEEN
Authorized Official Title or Position:
DC
Authorized Official Telephone Number:
919-779-2424

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1780 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0839A . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890839A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 330685 . This is a "ACN MCO - CIGNA AND UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 350041947 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 738056 . This is a "MAMSI PROVIDER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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