Provider Demographics
NPI:1407028756
Name:RALEIGH SPINE CENTER, PLLC
Entity Type:Organization
Organization Name:RALEIGH SPINE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEGROW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-620-7900
Mailing Address - Street 1:400 CRUTCHFIELD ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2771
Mailing Address - Country:US
Mailing Address - Phone:919-620-7900
Mailing Address - Fax:919-479-5061
Practice Address - Street 1:1425 ROCK QUARRY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4100
Practice Address - Country:US
Practice Address - Phone:919-620-7900
Practice Address - Fax:919-479-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1958111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08513OtherBCBS PROVIDER ID