Provider Demographics
NPI:1275708703
Name:CHAVEZ, W RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:W
Middle Name:RAYMOND
Last Name:CHAVEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WALLACE
Other - Middle Name:RAYMOND
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:462 MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-4487
Mailing Address - Country:US
Mailing Address - Phone:828-648-1122
Mailing Address - Fax:
Practice Address - Street 1:462 MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-4487
Practice Address - Country:US
Practice Address - Phone:828-681-0811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3747111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ28343Medicare PIN