Provider Demographics
NPI:1043326903
Name:AXELSSON, TINA SIGNE (DC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:SIGNE
Last Name:AXELSSON
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 1:7290 13 BEACH DRIVE SW
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469
Mailing Address - Country:US
Mailing Address - Phone:910-579-4888
Mailing Address - Fax:910-579-4888
Practice Address - Street 1:7290 13 BEACH DRIVE SW
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469
Practice Address - Country:US
Practice Address - Phone:910-579-4888
Practice Address - Fax:910-579-4888
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2768111N00000X
SC2423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890845GMedicaid
SCCH2423OtherMEDICAID
NCPB197QOtherSTRATUS
NCM451OtherEDI
NC0845GOtherBCBS
NCU78608Medicare UPIN
SCCH2423OtherMEDICAID