Provider Demographics
NPI:1033152806
Name:PAVKOV-POPOW, WENDY RENEE (DC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:RENEE
Last Name:PAVKOV-POPOW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 CROSSFIRE RD
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8560
Mailing Address - Country:US
Mailing Address - Phone:919-577-3974
Mailing Address - Fax:919-577-6351
Practice Address - Street 1:401 COOPER DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2817
Practice Address - Country:US
Practice Address - Phone:910-592-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085J2Medicaid
NC085J2OtherBC/BS PROVIDER NUMBER
NC085J2OtherBC/BS PROVIDER NUMBER
NC89085J2Medicaid