Provider Demographics
NPI:1093571721
Name:919 SPINE EAST WAKE SPORTS CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:919 SPINE EAST WAKE SPORTS CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-321-7584
Mailing Address - Street 1:210 W ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-7987
Mailing Address - Country:US
Mailing Address - Phone:518-321-7584
Mailing Address - Fax:919-342-6900
Practice Address - Street 1:210 W ACADEMY ST
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-7987
Practice Address - Country:US
Practice Address - Phone:518-321-7584
Practice Address - Fax:919-342-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-21
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty