Provider Demographics
NPI:1356842025
Name:CHOWAN CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:CHOWAN CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:CRANFORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:252-482-4900
Mailing Address - Street 1:701 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-1430
Mailing Address - Country:US
Mailing Address - Phone:252-482-4900
Mailing Address - Fax:252-482-1660
Practice Address - Street 1:701 N BROAD ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1430
Practice Address - Country:US
Practice Address - Phone:252-482-4900
Practice Address - Fax:252-482-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty