Provider Demographics
NPI:1316193303
Name:PAIN MANAGEMENT OF THE CAROLINAS
Entity Type:Organization
Organization Name:PAIN MANAGEMENT OF THE CAROLINAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA-MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-278-3513
Mailing Address - Street 1:8505 E OAK ISLAND DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OAK ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28465-8166
Mailing Address - Country:US
Mailing Address - Phone:910-278-3513
Mailing Address - Fax:
Practice Address - Street 1:8505 E OAK ISLAND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:OAK ISLAND
Practice Address - State:NC
Practice Address - Zip Code:28465-8166
Practice Address - Country:US
Practice Address - Phone:910-278-3513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2629111N00000X
NC3024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU74362Medicare UPIN
MOT88817Medicare UPIN