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1720645401 NPI number — RESTORATION CHIROPRACTIC LLC

NPI Number: 1720645401
Health Care Provider/Practitioner: RESTORATION CHIROPRACTIC LLC

Information about “1720645401” NPI (RESTORATION CHIROPRACTIC LLC) exists in 1720645401 in HTML format HTML  |  1720645401 in plain Text format TXT  |  1720645401 in PDF (Portable Document Format) PDF  |  1720645401 in an XML format XML  formats.

NPI Number : 1720645401 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720645401",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "RESTORATION CHIROPRACTIC LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5010 DAVIS LANT DR STE 4",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EVANSVILLE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47715-8947",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "812-604-5521",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5010 DAVIS LANT DR STE 4",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "EVANSVILLE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47715-8947",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-604-5521",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/29/2019",
    "LastUpdateDate": "10/15/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "KRACK",
    "AuthorizedOfficialFirstName": "RYAN",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DC",
    "AuthorizedOfficialTelephoneNumber": "812-604-5521",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QH0100X",
        "TaxonomyName": "Health Service Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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