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1336307206 NPI number — NATHAN CONRAD COFFIN DC

NPI Number: 1336307206
Health Care Provider/Practitioner: NATHAN CONRAD COFFIN DC

Information about “1336307206” NPI (NATHAN CONRAD COFFIN DC) exists in 1336307206 in HTML format HTML  |  1336307206 in plain Text format TXT  |  1336307206 in PDF (Portable Document Format) PDF  |  1336307206 in an XML format XML  formats.

NPI Number : 1336307206 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336307206",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COFFIN",
    "FirstName": "NATHAN",
    "MiddleName": "CONRAD",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "112 E OLIVE AVE",
    "SecondLineMailingAddress": "SUITE B",
    "MailingAddressCityName": "REDLANDS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92373-5281",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "909-793-9355",
    "MailingAddressFaxNumber": "909-793-9350",
    "FirstLinePracticeLocationAddress": "112 E OLIVE AVE",
    "SecondLinePracticeLocationAddress": "SUITE B",
    "PracticeLocationAddressCityName": "REDLANDS",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92373-5281",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "909-793-9355",
    "PracticeLocationAddressFaxNumber": "909-793-9350",
    "EnumerationDate": "05/28/2008",
    "LastUpdateDate": "05/28/2008",
    "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": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "19086",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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