1780896852 NPI number — DR. JOHN BRYAN SAPPINGTON DC

Table of content: DR. JOHN BRYAN SAPPINGTON DC (NPI 1780896852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780896852 NPI number — DR. JOHN BRYAN SAPPINGTON DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAPPINGTON
Provider First Name:
JOHN
Provider Middle Name:
BRYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

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:
1780896852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2722
Provider Second Line Business Mailing Address:
106 SIERRA GRANDE SUITE 100
Provider Business Mailing Address City Name:
RED OAK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75154-2445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-617-5600
Provider Business Mailing Address Fax Number:
972-617-5485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 SIERRA GRANDE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
RED OAK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75154-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-617-5600
Provider Business Practice Location Address Fax Number:
972-617-5485
Provider Enumeration Date:
05/03/2007

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:  8861 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 608289 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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