Provider Demographics
NPI:1124182019
Name:CHISHOLM, CHAD E (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1731
Mailing Address - Country:US
Mailing Address - Phone:919-829-5757
Mailing Address - Fax:919-829-5808
Practice Address - Street 1:605 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1731
Practice Address - Country:US
Practice Address - Phone:919-829-5757
Practice Address - Fax:919-829-5808
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890220VMedicaid
NC2448628BMedicare PIN
NC890220VMedicaid