1801092606 NPI number — MADER-DYE CHIROPRACTIC HEALTH CENTER, INC,

Table of content: (NPI 1801092606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801092606 NPI number — MADER-DYE CHIROPRACTIC HEALTH CENTER, INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADER-DYE CHIROPRACTIC HEALTH CENTER, INC,
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:
1801092606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 560
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMDENTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65020-0560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-346-2335
Provider Business Mailing Address Fax Number:
573-346-2334

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 CAMDEN COURT SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMDENTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-346-2335
Provider Business Practice Location Address Fax Number:
573-346-2334
Provider Enumeration Date:
06/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADER
Authorized Official First Name:
LODY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
573-346-2335

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CEOO6535 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: CEOO6520 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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