Provider Demographics
NPI:1114167061
Name:TRIANGLE WELLNESS & SPORTS CENTER
Entity Type:Organization
Organization Name:TRIANGLE WELLNESS & SPORTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-847-3555
Mailing Address - Street 1:182 WIND CHIME CT STE 203
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6483
Mailing Address - Country:US
Mailing Address - Phone:919-847-3555
Mailing Address - Fax:919-847-5338
Practice Address - Street 1:182 WIND CHIME CT STE 203
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6483
Practice Address - Country:US
Practice Address - Phone:919-847-3555
Practice Address - Fax:919-847-5338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2447289OtherMEDICARE PROVIDER #
U29008Medicare UPIN