1922290220 NPI number — ANDERSON FAMILY CHIROPRACTIC, LLC

Table of content: (NPI 1922290220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922290220 NPI number — ANDERSON FAMILY CHIROPRACTIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDERSON FAMILY CHIROPRACTIC, LLC
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:
1922290220
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43566-0254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-878-8312
Provider Business Mailing Address Fax Number:
419-878-8844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43566-1052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-878-8312
Provider Business Practice Location Address Fax Number:
419-878-8844
Provider Enumeration Date:
08/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
JAY
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
419-878-8312

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3256 , 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: U91632 . This is a "UPIN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2356445 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7580510 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 27882870801 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 27882870800 . This is a "WORKMAN'S COMPANSATION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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