1013405265 NPI number — SPRUCE PINE CHIROPRACTIC, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013405265 NPI number — SPRUCE PINE CHIROPRACTIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRUCE PINE CHIROPRACTIC, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1013405265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 CROSS ST STE 266
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRUCE PINE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28777-6160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-520-1800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 CROSS STREET
Provider Second Line Business Practice Location Address:
SUITE 266
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-520-1800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2018

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
QUINN
Authorized Official Title or Position:
OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
828-520-1800

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  4882 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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