1902959174 NPI number — CAPITOL CITY CHIROPRACTIC, INC.

Table of Contents

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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