Provider Demographics
NPI:1417140898
Name:CREECH CHIROPRACTIC CENTER DC PA
Entity Type:Organization
Organization Name:CREECH CHIROPRACTIC CENTER DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CREECH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:919-367-2828
Mailing Address - Street 1:800 W WILLIAMS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5203
Mailing Address - Country:US
Mailing Address - Phone:919-367-2828
Mailing Address - Fax:919-367-2822
Practice Address - Street 1:800 W WILLIAMS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-367-2828
Practice Address - Fax:919-367-2822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH89085KHMedicaid
OH89085KHMedicaid