1730324906 NPI number — YAQUINA CHIROPRACTIC LLC

Table of content: (NPI 1730324906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730324906 NPI number — YAQUINA CHIROPRACTIC LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAQUINA CHIROPRACTIC LLC
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:
1730324906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 SE DOUGLAS ST
Provider Second Line Business Mailing Address:
SUITE F-1
Provider Business Mailing Address City Name:
NEWPORT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-264-8138
Provider Business Mailing Address Fax Number:
541-264-8238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SE DOUGLAS ST
Provider Second Line Business Practice Location Address:
SUITE F-1
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-264-8138
Provider Business Practice Location Address Fax Number:
541-264-8238
Provider Enumeration Date:
12/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BISHOP
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
STANLEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
541-264-8138

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R146211 . This is a "MEDICARE PTAN" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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