1720327018 NPI number — DRIVERE CHIROPRACTIC & WELLNESS P.C.

Table of content: (NPI 1720327018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720327018 NPI number — DRIVERE CHIROPRACTIC & WELLNESS P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DRIVERE CHIROPRACTIC & WELLNESS P.C.
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:
1720327018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
212 W VINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW WILMINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16142-1206
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-946-9410
Provider Business Mailing Address Fax Number:
724-946-9411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
212 W VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW WILMINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16142-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-946-9410
Provider Business Practice Location Address Fax Number:
724-946-9411
Provider Enumeration Date:
02/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DRIVERE
Authorized Official First Name:
JASON
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
724-946-9410

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC009266 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001638338 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 6882206 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1017114200001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 695320 . This is a "OPTUM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 421641217 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7432637 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 210569918001 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 720816 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1557167 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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