Provider Demographics
NPI:1326155078
Name:CROSSROADS FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:CROSSROADS FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-989-1888
Mailing Address - Street 1:58 OLD ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:NC
Mailing Address - Zip Code:27504-9998
Mailing Address - Country:US
Mailing Address - Phone:919-989-1888
Mailing Address - Fax:919-989-1898
Practice Address - Street 1:58 OLD ROBERTS RD
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:NC
Practice Address - Zip Code:27504-9998
Practice Address - Country:US
Practice Address - Phone:919-989-1888
Practice Address - Fax:919-989-1898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSSROADS FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty