Provider Demographics
NPI:1316045065
Name:RIVER CITY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:RIVER CITY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MAWHINEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-335-7709
Mailing Address - Street 1:224 N POINDEXTER ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4414
Mailing Address - Country:US
Mailing Address - Phone:252-335-7709
Mailing Address - Fax:252-331-7997
Practice Address - Street 1:224 N POINDEXTER ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4414
Practice Address - Country:US
Practice Address - Phone:252-335-7709
Practice Address - Fax:252-331-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2338111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0833NOtherBC/BS NC
NC890833NMedicaid
NC2454215Medicare ID - Type Unspecified
NC0833NOtherBC/BS NC