Provider Demographics
NPI:1033485727
Name:O'BRIANT CHIROPRACTIC HEALTH CENTER, PA
Entity Type:Organization
Organization Name:O'BRIANT CHIROPRACTIC HEALTH CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIANT
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:919-570-6511
Mailing Address - Street 1:1986 SOUTH MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6465
Mailing Address - Country:US
Mailing Address - Phone:919-570-6511
Mailing Address - Fax:919-570-8299
Practice Address - Street 1:1986 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9336
Practice Address - Country:US
Practice Address - Phone:919-570-6511
Practice Address - Fax:919-570-8299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2736111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454010Medicare PIN