1689972598 NPI number — MRS. CHRISTA DAWN BALCHUNAS BA

Table of content: MRS. CHRISTA DAWN BALCHUNAS BA (NPI 1689972598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689972598 NPI number — MRS. CHRISTA DAWN BALCHUNAS BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALCHUNAS
Provider First Name:
CHRISTA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RASCHKE
Provider Other First Name:
CHRISTA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689972598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2708 NE 14TH ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
POMPANO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33062-3565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-603-7885
Provider Business Mailing Address Fax Number:
954-342-0273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2708 NE 14TH ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33062-3565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-603-7885
Provider Business Practice Location Address Fax Number:
954-342-0273
Provider Enumeration Date:
03/02/2011

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: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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