Provider Demographics
NPI:1114189297
Name:CREEDMOOR CHIROPRACTIC
Entity Type:Organization
Organization Name:CREEDMOOR CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RONCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-846-7246
Mailing Address - Street 1:7501 CREEDMOOR RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1680
Mailing Address - Country:US
Mailing Address - Phone:919-846-7246
Mailing Address - Fax:919-846-8440
Practice Address - Street 1:7501 CREEDMOOR RD
Practice Address - Street 2:SUITE 112
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1680
Practice Address - Country:US
Practice Address - Phone:919-846-7246
Practice Address - Fax:919-846-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2720111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890842CMedicaid
NC890842CMedicaid
2453998BMedicare PIN