Provider Demographics
NPI:1225303357
Name:CYPRESS CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:CYPRESS CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:910-457-1919
Mailing Address - Street 1:814 N HOWE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:NC
Mailing Address - Zip Code:28461-3462
Mailing Address - Country:US
Mailing Address - Phone:910-457-1919
Mailing Address - Fax:910-457-1914
Practice Address - Street 1:814 N HOWE ST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:NC
Practice Address - Zip Code:28461-3462
Practice Address - Country:US
Practice Address - Phone:910-457-1919
Practice Address - Fax:910-457-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1925111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty