1366707853 NPI number — WORKMAN FAMILY CHIROPRACTIC PLLC

Table of content: (NPI 1366707853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366707853 NPI number — WORKMAN FAMILY CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORKMAN FAMILY 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:
1366707853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5183 CLINTON RD
Provider Second Line Business Mailing Address:
STE101
Provider Business Mailing Address City Name:
STEDMAN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28391-9523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5183 CLINTON RD
Provider Second Line Business Practice Location Address:
STE101
Provider Business Practice Location Address City Name:
STEDMAN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28391-9523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-482-4444
Provider Business Practice Location Address Fax Number:
910-482-4441
Provider Enumeration Date:
07/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WORKMAN
Authorized Official First Name:
LUCCUS
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/MEMBER
Authorized Official Telephone Number:
919-593-5809

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3494 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 3470 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1225133515 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1487789277 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7908968 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com