Provider Demographics
NPI:1225203482
Name:ESSMAN CHIROPRACTIC & WELLNESS CENTER PLLC
Entity Type:Organization
Organization Name:ESSMAN CHIROPRACTIC & WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ESSMAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:910-754-5678
Mailing Address - Street 1:4501 MAIN ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4589
Mailing Address - Country:US
Mailing Address - Phone:910-754-5678
Mailing Address - Fax:910-754-5679
Practice Address - Street 1:4501 MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4589
Practice Address - Country:US
Practice Address - Phone:910-754-5678
Practice Address - Fax:910-754-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1773261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2447124AOtherINDIVIDUAL MEDICARE#
NC1568573970OtherINDIVIDUAL NPI #
NC890838CMedicaid
NC1568573970OtherINDIVIDUAL NPI #