Provider Demographics
NPI:1114946332
Name:CRABTREE CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:CRABTREE CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:KUBASKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-781-8830
Mailing Address - Street 1:4517 LEAD MINE RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3326
Mailing Address - Country:US
Mailing Address - Phone:919-781-8830
Mailing Address - Fax:919-781-1678
Practice Address - Street 1:4517 LEAD MINE RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3326
Practice Address - Country:US
Practice Address - Phone:919-781-8830
Practice Address - Fax:919-781-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0821FOtherBLUE CROSS BLUE SHIELD
NC890821FMedicaid
2344953Medicare PIN
NC0821FOtherBLUE CROSS BLUE SHIELD