1902959174 NPI number — CAPITOL CITY CHIROPRACTIC, INC.

Table of content: MR. NATHAN SWAIN MARSH (NPI 1669633863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902959174 NPI number — CAPITOL CITY CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL CITY 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:
1902959174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1835 NW TOPEKA BLVD
Provider Second Line Business Mailing Address:
SUITE 209
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66608-1888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-234-0900
Provider Business Mailing Address Fax Number:
785-234-5832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1835 NW TOPEKA BLVD
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66608-1888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-234-0900
Provider Business Practice Location Address Fax Number:
785-234-5832
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CHANCE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
785-234-0900

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH3938 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 062443 . This is a "BCBS PIN #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 660188 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: P00896062 . This is a "MEDICARE PROVIDER PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 350048346 . This is a "RR MEDICARE PROVIDER #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: DR2741 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 001960184003 . This is a "UNITED HEALTHCARE PROV #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 0007402220 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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