1770667784 NPI number — CORDES CHIROPRACTIC CENTER

Table of content: (NPI 1770667784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770667784 NPI number — CORDES CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORDES CHIROPRACTIC CENTER
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:
1770667784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1035 W WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPOLEON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43545-1357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-592-6050
Provider Business Mailing Address Fax Number:
309-210-7509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPOLEON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43545-1357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-592-6050
Provider Business Practice Location Address Fax Number:
309-210-7509
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORDES
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
419-592-6050

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 351086 . This is a "BC/BS OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04183 . This is a "PARAMOUNT HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 275726544003 . This is a "HMO HEALTH OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 275726544003 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04183 . This is a "PARAMOUNT PREFERRED OPTIONS-MMA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 351086 . This is a "OHIO OPERAT ENGINEERS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 351086 . This is a "ANTHEM BC/BS OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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