1730355769 NPI number — LEXINGTON CHIROPRACTIC AND WELLNESS, P.A.

Table of content: (NPI 1730355769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730355769 NPI number — LEXINGTON CHIROPRACTIC AND WELLNESS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEXINGTON CHIROPRACTIC AND WELLNESS, P.A.
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:
1730355769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 S STATE ST
Provider Second Line Business Mailing Address:
STE 1
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27292-3373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-248-5200
Provider Business Mailing Address Fax Number:
336-249-3200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S STATE ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27292-3373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-248-5200
Provider Business Practice Location Address Fax Number:
336-249-3200
Provider Enumeration Date:
04/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TUSSEY
Authorized Official First Name:
SARA
Authorized Official Middle Name:
VIRGINIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
336-248-5200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3391 , 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: 5902167 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 086CA . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com