1558421990 NPI number — MONIT CHIROPRACTIC

Table of content: (NPI 1558421990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558421990 NPI number — MONIT CHIROPRACTIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONIT 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:
1558421990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
373 VIRGINIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15074-1766
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-775-1322
Provider Business Mailing Address Fax Number:
724-775-2527

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
373 VIRGINIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15074-1766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-775-1322
Provider Business Practice Location Address Fax Number:
724-775-2527
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONIT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
CHIROPRACTOR
Authorized Official Telephone Number:
724-775-1322

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC001411-L , 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: 2134946 . This is a "UHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 221427 . This is a "HEALTH AMERICAASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 317600 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11025789 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2795032 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7138334 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2681891 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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