Provider Demographics
NPI:1104218536
Name:STAGECOACH FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:STAGECOACH FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-630-4821
Mailing Address - Street 1:6000 MEADOWBROOK MALL CT STE 3A
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8775
Mailing Address - Country:US
Mailing Address - Phone:336-893-5662
Mailing Address - Fax:
Practice Address - Street 1:6000 MEADOWBROOK MALL CT STE 3A
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8775
Practice Address - Country:US
Practice Address - Phone:336-893-5662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty