Provider Demographics
NPI:1265851430
Name:TRIAD FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:TRIAD FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMLEY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:336-263-9291
Mailing Address - Street 1:900 OLD WINSTON RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9964
Mailing Address - Country:US
Mailing Address - Phone:336-263-9291
Mailing Address - Fax:
Practice Address - Street 1:900 OLD WINSTON RD
Practice Address - Street 2:SUITE 208
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9964
Practice Address - Country:US
Practice Address - Phone:336-263-9291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4085111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty