1801832811 NPI number — LAKE NORMAN CHIROPRACTIC CENTER

Table of content: (NPI 1801832811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801832811 NPI number — LAKE NORMAN CHIROPRACTIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE NORMAN 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:
1801832811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28115-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-664-3455
Provider Business Mailing Address Fax Number:
704-664-2827

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
612 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOORESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28115-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-664-3455
Provider Business Practice Location Address Fax Number:
704-664-2827
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABERNATHY
Authorized Official First Name:
TODD
Authorized Official Middle Name:
FULTON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
704-664-3455

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NS0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 085A6 . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 42162996 . This is a "WAUSAU" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 617420 . This is a "ACN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 53164 . This is a "AWHN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 350053151 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7741266 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0194L . This is a "CNC (BCBS)" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 208640 . This is a "QUAILCHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 43954 . This is a "PARTNERS INDIVIDUAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 4881 . This is a "PARTNERS GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5909823002 . This is a "CIGNA PAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89085A6 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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