1497915482 NPI number — DISCOVER CHIROPRACTIC

Table of content: (NPI 1497915482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497915482 NPI number — DISCOVER CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISCOVER CHIROPRACTIC
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:
1497915482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6425 S PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
STE 17
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48911-5975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-393-8800
Provider Business Mailing Address Fax Number:
517-393-9000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6425 S PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
STE 17
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48911-5975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-393-8800
Provider Business Practice Location Address Fax Number:
517-393-9000
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCHENRY
Authorized Official First Name:
TROY
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-393-8800

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2301008401 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1001609 . This is a "MCLAREN MEDICAID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 950C350910 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 950C350910 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1018045 . This is a "MCLAREN HEALTH ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N30100 . This is a "MEDICARE ADVANTAGE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 133365 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 200000002377 . This is a "PHP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 8115915 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0N30100 . This is a "MEDICARE PLUS BLUE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4308531 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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