1912265307 NPI number — MCNAMARA CHIROPRACTIC CENTER, P.A.

Table of content: DR. KEVIN DAVID SUNTKEN D.C. (NPI 1144771858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912265307 NPI number — MCNAMARA CHIROPRACTIC CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCNAMARA CHIROPRACTIC CENTER, P.A.
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:
1912265307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3320 N FEDERAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIGHTHOUSE POINT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33064-6742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-943-1100
Provider Business Mailing Address Fax Number:
954-943-9226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 N FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIGHTHOUSE POINT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-6742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-943-1100
Provider Business Practice Location Address Fax Number:
954-943-9226
Provider Enumeration Date:
04/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KRAUSS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
MCNAMARA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-943-1100

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 70863 . This is a "BLUE CROSS AND BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 380434800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 011015200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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