Provider Demographics
NPI:1154827467
Name:GREATEST POTENTIAL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GREATEST POTENTIAL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WOODBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-477-3661
Mailing Address - Street 1:323 AIRPORT RD STE C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5701
Mailing Address - Country:US
Mailing Address - Phone:334-321-7275
Mailing Address - Fax:888-505-3765
Practice Address - Street 1:2013 OLDE REGENT WAY STE 170
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-4194
Practice Address - Country:US
Practice Address - Phone:910-477-3661
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty