1821160698 NPI number — DR. AMANDA BETH BORRE D.C.

Table of content: DR. AMANDA BETH BORRE D.C. (NPI 1821160698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821160698 NPI number — DR. AMANDA BETH BORRE D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORRE
Provider First Name:
AMANDA
Provider Middle Name:
BETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

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:
1821160698
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3015 E NEW YORK ST
Provider Second Line Business Mailing Address:
SUITE A11
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60504-5162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-820-1330
Provider Business Mailing Address Fax Number:
630-820-1554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3015 E NEW YORK ST
Provider Second Line Business Practice Location Address:
SUITE A11
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60504-5162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-820-1330
Provider Business Practice Location Address Fax Number:
630-820-1554
Provider Enumeration Date:
11/15/2006

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: 111N00000X , with the licence number:  038009855 , 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)

  • Identifier: 7282480 . This is a "DR BORRE ID-AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 996513 . This is a "GALAXY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 02232251 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2122346216301 . This is a "BEECH STREET" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 6937 . This is a "UNITED HEALTH SERVICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 038009855 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 661636 . This is a "AMERICAN CHIROPRACTIC NET" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 7466464 . This is a "CLINIC ID-AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 660636 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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