1235319674 NPI number — ALDEN BRIDGE CHIROPRATIC CENTER PA

Table of content: (NPI 1235319674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235319674 NPI number — ALDEN BRIDGE CHIROPRATIC CENTER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALDEN BRIDGE CHIROPRATIC CENTER PA
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:
1235319674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25802 INTERSTATE 45
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77386-1032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-367-8101
Provider Business Mailing Address Fax Number:
281-367-8209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25802 INTERSTATE 45
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77386-1032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-367-8101
Provider Business Practice Location Address Fax Number:
281-367-8209
Provider Enumeration Date:
11/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CIANCIULLI
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-367-8101

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6976 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0010HD . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DF2635 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".