Provider Demographics
NPI:1215194311
Name:NEW BRANCH CHIROPRACTIC & HEALTH CENTER, PLLC
Entity Type:Organization
Organization Name:NEW BRANCH CHIROPRACTIC & HEALTH CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQULYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NYGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-642-0555
Mailing Address - Street 1:120 LOWES DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8306
Mailing Address - Country:US
Mailing Address - Phone:919-642-0555
Mailing Address - Fax:919-642-0556
Practice Address - Street 1:120 LOWES DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8306
Practice Address - Country:US
Practice Address - Phone:919-642-0555
Practice Address - Fax:919-642-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3694261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center