Provider Demographics
NPI:1073654760
Name:CAGLE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CAGLE CHIROPRACTIC, PLLC
Other - Org Name:CAGLE CHIROPRACTIC NECK & BACK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-332-1990
Mailing Address - Street 1:PO BOX 823
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0823
Mailing Address - Country:US
Mailing Address - Phone:252-332-1990
Mailing Address - Fax:252-332-7620
Practice Address - Street 1:403 MAIN ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3321
Practice Address - Country:US
Practice Address - Phone:252-332-1990
Practice Address - Fax:252-332-7620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2075261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890829UMedicaid
NC$$$$$$$$$OtherV. L. CAGLE'S SSN
NC0829TOtherV.. L. CAGLE'S BCBSNC #
NC$$$$$$$$$OtherL. S. CAGLE'S SSN
NC0829UOtherL. S. CAGLE'S BCBSNC #