Provider Demographics
NPI:1164670857
Name:MAIN STREET CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:MAIN STREET CHIROPRACTIC CENTER, PA
Other - Org Name:OAK ISLAND CHIROPRACTIC & ALTERNATIVE HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSSON-SKIPPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-278-3513
Mailing Address - Street 1:PO BOX 1046
Mailing Address - Street 2:
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-9820
Mailing Address - Country:US
Mailing Address - Phone:910-278-3513
Mailing Address - Fax:
Practice Address - Street 1:8505 E OAK ISLAND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-8166
Practice Address - Country:US
Practice Address - Phone:910-278-3513
Practice Address - Fax:910-278-3469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890845XMedicaid
NCU74362Medicare UPIN