1841526092 NPI number — EVANSTON CHIROPRACTIC CENTER INC.

Table of content: (NPI 1841526092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841526092 NPI number — EVANSTON CHIROPRACTIC CENTER INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANSTON CHIROPRACTIC 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:
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:
1841526092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 W CHEYENNE DR STE 3
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82930-5517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-789-4957
Provider Business Mailing Address Fax Number:
307-789-4959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 W CHEYENNE DR STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82930-5517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-679-4429
Provider Business Practice Location Address Fax Number:
307-789-4959
Provider Enumeration Date:
10/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DILLREE
Authorized Official First Name:
DEE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
307-789-4957

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  516 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com