Provider Demographics
NPI:1225176829
Name:MOUNTAIN COMMUNITY CHIROPRACTIC AND HEALING ARTS CENTER
Entity Type:Organization
Organization Name:MOUNTAIN COMMUNITY CHIROPRACTIC AND HEALING ARTS CENTER
Other - Org Name:MOUNTAIN COMMUNITY CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIRRELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:MAGNUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-452-9060
Mailing Address - Street 1:33 VALLEY VIEW TER
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-4548
Mailing Address - Country:US
Mailing Address - Phone:828-452-9060
Mailing Address - Fax:
Practice Address - Street 1:33 VALLEY VIEW TER
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-4548
Practice Address - Country:US
Practice Address - Phone:828-452-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454165Medicare ID - Type Unspecified