1780671420 NPI number — DR. CANDACE LAW D.C.

Table of content: DR. CANDACE LAW D.C. (NPI 1780671420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780671420 NPI number — DR. CANDACE LAW D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAW
Provider First Name:
CANDACE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1780671420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 S FORREST ST
Provider Second Line Business Mailing Address:
P.O. BOX 382
Provider Business Mailing Address City Name:
DOUGLASS
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67039-8829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-746-2201
Provider Business Mailing Address Fax Number:
316-746-2245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 S FORREST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLASS
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67039-8829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-746-2201
Provider Business Practice Location Address Fax Number:
316-746-2245
Provider Enumeration Date:
09/27/2005

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: 111N00000X , with the licence number:  4849 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 62456 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 9308350 . This is a "PHCS, FAMILY HEALTH AMERICA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 9085125 . This is a "CIGNA" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00182560 . This is a "RAILROAD MEDICARE #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 8187 . This is a "PHS PROVIDER #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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