Provider Demographics
NPI:1043754344
Name:1ST CHOICE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:1ST CHOICE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:STOGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-895-6042
Mailing Address - Street 1:936 CIRCLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-4526
Mailing Address - Country:US
Mailing Address - Phone:910-895-6042
Mailing Address - Fax:910-895-3199
Practice Address - Street 1:936 CIRCLEWOOD DR
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4526
Practice Address - Country:US
Practice Address - Phone:910-895-6042
Practice Address - Fax:910-895-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4099111N00000X
NC1885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty