Provider Demographics
NPI:1013372549
Name:BRYSON CITY CHIROPRACTIC AND WELLNESS, INC.
Entity Type:Organization
Organization Name:BRYSON CITY CHIROPRACTIC AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-488-7979
Mailing Address - Street 1:264 HIGHWAY 19 S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRYSON CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28713-9513
Mailing Address - Country:US
Mailing Address - Phone:828-488-7979
Mailing Address - Fax:828-412-0298
Practice Address - Street 1:264 HIGHWAY 19 S
Practice Address - Street 2:SUITE 3
Practice Address - City:BRYSON CITY
Practice Address - State:NC
Practice Address - Zip Code:28713-9513
Practice Address - Country:US
Practice Address - Phone:828-488-7979
Practice Address - Fax:828-412-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty