1457763393 NPI number — FOUNDATION CHIROPRACTIC, P.C.

Table of content: (NPI 1457763393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457763393 NPI number — FOUNDATION CHIROPRACTIC, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNDATION CHIROPRACTIC, P.C.
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:
1457763393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13213 HARDIN WAPAKONETA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45302-9690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-726-9280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6245 EMERALD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUBLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43016-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-726-9280
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOYING
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
937-726-9280

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4440 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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