Provider Demographics
NPI:1265630891
Name:JOHN R. DABBS JR. DC PC
Entity Type:Organization
Organization Name:JOHN R. DABBS JR. DC PC
Other - Org Name:EDEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:DABBS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC PC
Authorized Official - Phone:336-627-7398
Mailing Address - Street 1:405 BOONE RD
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-4967
Mailing Address - Country:US
Mailing Address - Phone:336-627-7398
Mailing Address - Fax:
Practice Address - Street 1:405 BOONE ROAD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288
Practice Address - Country:US
Practice Address - Phone:336-627-7398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2329305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherEIN