1912047911 NPI number — DR. TED J DUNN D.C.

Table of content: DR. TED J DUNN D.C. (NPI 1912047911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912047911 NPI number — DR. TED J DUNN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNN
Provider First Name:
TED
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1912047911
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1530 N BRIDGE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHILLICOTHEE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45601-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-773-5858
Provider Business Mailing Address Fax Number:
740-773-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1530 N BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILLICOTHEE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45601-4104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-773-5858
Provider Business Practice Location Address Fax Number:
740-773-5860
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  573 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000117538 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "AAA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "ANTHEM MANAGED COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "OHIO OPERATING ENGINEERS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "ANTHEM BENEFIT ADMIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "ONE NATION BENEFIT ADMIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "ADMINIS ENTERPRISE, INC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "NATIONWIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "STATE FARM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000117538 . This is a "TRAVELERS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0152294 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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