Provider Demographics
NPI:1265489074
Name:TURNER LIFE CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:TURNER LIFE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROWLAND
Authorized Official - Middle Name:GOODRICH
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-659-0503
Mailing Address - Street 1:4712 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3749
Mailing Address - Country:US
Mailing Address - Phone:336-659-0503
Mailing Address - Fax:336-659-2660
Practice Address - Street 1:4712 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3749
Practice Address - Country:US
Practice Address - Phone:336-659-0503
Practice Address - Fax:336-659-2660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244375Medicare ID - Type Unspecified
NC244375Medicare PIN