1659533818 NPI number — FAMILY WELLNESS CHIROPRACTIC, PA

Table of content: CHRISTINA JOY CARR LCSW (NPI 1992697668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659533818 NPI number — FAMILY WELLNESS CHIROPRACTIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY WELLNESS CHIROPRACTIC, PA
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:
1659533818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4229 LOUISBURG RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27604-4345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-872-1130
Provider Business Mailing Address Fax Number:
919-872-1125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4229 LOUISBURG RD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27604-4345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-872-1130
Provider Business Practice Location Address Fax Number:
919-872-1125
Provider Enumeration Date:
06/30/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOGAN
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
FOSTER
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
919-872-1130

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2535 , 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)

  • Identifier: 7908255 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".