1285857128 NPI number — SAVONA FAMILY CHIROPRACTIC, INC

Table of content: (NPI 1285857128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285857128 NPI number — SAVONA FAMILY CHIROPRACTIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAVONA FAMILY CHIROPRACTIC, INC
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:
1285857128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 N MAIN ST STE 201
Provider Second Line Business Mailing Address:
PO BOX 265
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18917-2107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-249-9200
Provider Business Mailing Address Fax Number:
215-249-3118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 N MAIN ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18917-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-249-9200
Provider Business Practice Location Address Fax Number:
215-249-3118
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAVONA
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-249-9200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC008804 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2341923000 . This is a "IBC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2341923000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1660754 . This is a "HIGHMARK BLUESHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003846437 . This is a "NPI PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2341923000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3795620 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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