1932120722 NPI number — DR. EDWARD ALLEN KLUMPP SR. DC

Table of content: DR. EDWARD ALLEN KLUMPP SR. DC (NPI 1932120722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932120722 NPI number — DR. EDWARD ALLEN KLUMPP SR. DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLUMPP
Provider First Name:
EDWARD
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLUMPP
Provider Other First Name:
E
Provider Other Middle Name:
ALLEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
SR.
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932120722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
310 W WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MARQUETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49855-4334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-228-9800
Provider Business Mailing Address Fax Number:
906-228-9801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855-4334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-228-9800
Provider Business Practice Location Address Fax Number:
906-228-9801
Provider Enumeration Date:
07/21/2006

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:  2301008874 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0E21067 . This is a "BCBSM PERSONAL PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: DP2446 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 950E210670 . This is a "BCBSM PROVIDER NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: MI1807001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00305960 . This is a "RAILROAD MEDICARE PIN NUM" identifier . This identifiers is of the category "OTHER".




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