1043644313 NPI number — BLACK MOUNTAIN FAMILY CHIROPRACTIC AND WELLNESS CENTER

Table of content: JAYSON STEWART BA, MSW (NPI 1275977464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043644313 NPI number — BLACK MOUNTAIN FAMILY CHIROPRACTIC AND WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACK MOUNTAIN FAMILY CHIROPRACTIC AND WELLNESS 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:
6
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:
1043644313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 SWANNANOA RIVER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28805-2335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-848-8709
Provider Business Mailing Address Fax Number:
828-848-8703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 RICHARDSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLACK MOUNTAIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28711-3526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-848-8709
Provider Business Practice Location Address Fax Number:
828-848-8703
Provider Enumeration Date:
08/22/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GELINEAU
Authorized Official First Name:
ALAINA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER, CHIROPRACTOR
Authorized Official Telephone Number:
828-772-5053

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4360 , 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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