1871563619 NPI number — TEJAN CHIROPRACTIC INC

Table of content: (NPI 1871563619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871563619 NPI number — TEJAN CHIROPRACTIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEJAN CHIROPRACTIC 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:
1871563619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4012 JORDAN STREET, BOX 420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH HEIGHTS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15081-0420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-375-5534
Provider Business Mailing Address Fax Number:
724-375-5575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4012 JORDAN STREET, BOX 420
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH HEIGHTS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15081-0420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-375-5534
Provider Business Practice Location Address Fax Number:
724-375-5575
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TEJAN
Authorized Official First Name:
MARK
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-375-5534

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC003643L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 329860 . This is a "HEALTH AMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0011157650001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 381900 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1198057 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 141190 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2675833 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1984961-01 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MT382067 . This is a "ASHN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0004258151 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001465580 . This is a "HIGHMARK BC BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200146 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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