Provider Demographics
NPI:1033278080
Name:BAGWELL CHIROPRACTIC PA
Entity Type:Organization
Organization Name:BAGWELL CHIROPRACTIC PA
Other - Org Name:LIFESPRING CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BAGWELL
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:704-947-2902
Mailing Address - Street 1:10215 HICKORYWOOD HILL AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3429
Mailing Address - Country:US
Mailing Address - Phone:704-947-2902
Mailing Address - Fax:704-947-2910
Practice Address - Street 1:10215 HICKORYWOOD HILL AVE STE A
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3429
Practice Address - Country:US
Practice Address - Phone:704-947-2902
Practice Address - Fax:704-947-2910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty