1992878821 NPI number — MRS. INGRID ROSE JOHNSON RODRIGUEZ DC

Table of content: MRS. INGRID ROSE JOHNSON RODRIGUEZ DC (NPI 1992878821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992878821 NPI number — MRS. INGRID ROSE JOHNSON RODRIGUEZ DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON RODRIGUEZ
Provider First Name:
INGRID
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1992878821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19364
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-392-2633
Provider Business Mailing Address Fax Number:
336-856-7296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
851 OLD WINSTON RD SUITE 105
Provider Second Line Business Practice Location Address:
PIEDMONT CHIROPRACTIC CENTER
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-993-9690
Provider Business Practice Location Address Fax Number:
336-993-9692
Provider Enumeration Date:
11/16/2006

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:  2778 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890845A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 645599 . This is a "AEN UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2024753 . This is a "1ST HEALTH NETWORK" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 9156656 . This is a "PHCS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".