Provider Demographics
NPI:1003029463
Name:CENTRAL CAROLINA CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:CENTRAL CAROLINA CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TYNDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-629-7246
Mailing Address - Street 1:103 W WAINMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5623
Mailing Address - Country:US
Mailing Address - Phone:336-629-7246
Mailing Address - Fax:336-629-1984
Practice Address - Street 1:103 W WAINMAN AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5623
Practice Address - Country:US
Practice Address - Phone:336-629-7246
Practice Address - Fax:336-629-1984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1478111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908881Medicaid
NC08881OtherBCBS
NCT64496Medicare UPIN
NC244470AMedicare ID - Type Unspecified