Provider Demographics
NPI:1356847164
Name:STRUCTURAL CHIROPRACTIC OF NORTH CAROLINA
Entity Type:Organization
Organization Name:STRUCTURAL CHIROPRACTIC OF NORTH CAROLINA
Other - Org Name:STRUCTURL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-241-9519
Mailing Address - Street 1:1125 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4566
Mailing Address - Country:US
Mailing Address - Phone:919-467-7797
Mailing Address - Fax:
Practice Address - Street 1:1125 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4566
Practice Address - Country:US
Practice Address - Phone:919-467-7797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC04792261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center