1396728051 NPI number — MR. SEAN MICHAEL MCNEIL ATC, CSCS

Table of content: MR. SEAN MICHAEL MCNEIL ATC, CSCS (NPI 1396728051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396728051 NPI number — MR. SEAN MICHAEL MCNEIL ATC, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNEIL
Provider First Name:
SEAN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ATC, CSCS
Provider Gender Code:
M

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:
1396728051
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:
646 ADAMS ST
Provider Second Line Business Mailing Address:
UNIT GW
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60304-1334
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-329-3932
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 N LASALLE ST
Provider Second Line Business Practice Location Address:
SOLHEIM CENTER
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60610-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-329-2252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2005

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: 2255A2300X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com