Provider Demographics
NPI:1225117427
Name:LINEBERRY CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:LINEBERRY CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:LINEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-548-2225
Mailing Address - Street 1:901 S AYERSVILLE RD
Mailing Address - Street 2:PO BOX 10
Mailing Address - City:MAYODAN
Mailing Address - State:NC
Mailing Address - Zip Code:27027-2957
Mailing Address - Country:US
Mailing Address - Phone:336-548-2225
Mailing Address - Fax:
Practice Address - Street 1:901 S AYERSVILLE RD
Practice Address - Street 2:
Practice Address - City:MAYODAN
Practice Address - State:NC
Practice Address - Zip Code:27027-2957
Practice Address - Country:US
Practice Address - Phone:336-548-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908264Medicaid
NC0826UOtherBLUE CROSS BLUE SHIELD
NCU67259Medicare UPIN
2451479Medicare PIN