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1073660551 NPI number — JOHN W. POWELL PHD, ATC

NPI Number: 1073660551
Health Care Provider/Practitioner: JOHN W. POWELL PHD, ATC

Information about “1073660551” NPI (JOHN W. POWELL PHD, ATC) exists in 1073660551 in HTML format HTML  |  1073660551 in plain Text format TXT  |  1073660551 in PDF (Portable Document Format) PDF  |  1073660551 in an XML format XML  formats.

NPI Number : 1073660551 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073660551",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POWELL",
    "FirstName": "JOHN",
    "MiddleName": "W.",
    "NamePrefix": "PROF.",
    "NameSuffix": null,
    "Credential": "PHD, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6461 PLEASANT RIVER DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DIMONDALE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48821-9707",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "517-646-6310",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "105 IM CIRCLE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EAST LANSING",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48824-1020",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "517-432-5018",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/05/2007",
    "LastUpdateDate": "07/08/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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