1881790848 NPI number — WILLEN CHIROPRACTIC CENTER

Table of content: (NPI 1881790848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881790848 NPI number — WILLEN CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLEN CHIROPRACTIC CENTER
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:
1881790848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3808 HIGH POINT RD
Provider Second Line Business Mailing Address:
SUTIE H
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27407-4713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-855-8560
Provider Business Mailing Address Fax Number:
336-855-5938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3808 HIGH POINT RD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27407-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-855-8560
Provider Business Practice Location Address Fax Number:
336-855-5938
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLEN
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-855-8560

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  NC1406 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08922 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 330532 . This is a "ACN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5175103 . This is a "FIRST HEALTH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8444 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8908922 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44-09021 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 24885 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 11008887 . This is a "CAQH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 282687 . This is a "PHCS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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