1871515981 NPI number — BACK TO HEALTH CHIROPRACTIC P C

Table of content: MISS RACHEL LYNN MCCARTHY (NPI 1174169981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871515981 NPI number — BACK TO HEALTH CHIROPRACTIC P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK TO HEALTH CHIROPRACTIC P C
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:
1871515981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 128
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74834-0128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-258-0014
Provider Business Mailing Address Fax Number:
405-258-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 MANVEL AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHANDLER
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74834-4401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-258-0014
Provider Business Practice Location Address Fax Number:
405-258-0094
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIVIS
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
405-258-0014

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3592 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 446605938 003 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00135785 DB9021 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com