Provider Demographics
NPI:1275623282
Name:PRIESTER, JOHN J (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:PRIESTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2464
Mailing Address - Country:US
Mailing Address - Phone:704-375-8264
Mailing Address - Fax:704-335-0940
Practice Address - Street 1:1726 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2464
Practice Address - Country:US
Practice Address - Phone:704-375-8264
Practice Address - Fax:704-335-0940
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908725Medicaid
NC08725OtherNCBCBS
NC4337281OtherAETNA
NC244349Medicare PIN
NC08725OtherNCBCBS