Provider Demographics
NPI:1417405101
Name:PEAK CHIROPRACTIC
Entity Type:Organization
Organization Name:PEAK CHIROPRACTIC
Other - Org Name:PEAK CHIROPRACTIC AND FUNCTIONAL WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-699-8184
Mailing Address - Street 1:211 E SIX FORKS RD STE 207
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7755
Mailing Address - Country:US
Mailing Address - Phone:919-699-8184
Mailing Address - Fax:
Practice Address - Street 1:211 E SIX FORKS RD STE 207
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7755
Practice Address - Country:US
Practice Address - Phone:919-699-8184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4646111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty