1932372521 NPI number — KERNERSVILLE CHIROPRACTIC CENTER

Table of content: (NPI 1932372521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932372521 NPI number — KERNERSVILLE CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERNERSVILLE CHIROPRACTIC CENTER
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:
1932372521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 707
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KERNERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27285-0707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-996-2462
Provider Business Mailing Address Fax Number:
336-996-9878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284-2815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-996-2462
Provider Business Practice Location Address Fax Number:
336-996-9878
Provider Enumeration Date:
04/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DARIAN
Authorized Official Middle Name:
JUSTIN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-996-2462

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1999 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 3796 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , 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: 5908470 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890879B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2448242 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2456015 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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