Provider Demographics
NPI:1437218716
Name:TRIANGLE CHIROPRACTIC
Entity Type:Organization
Organization Name:TRIANGLE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:RUDERFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-544-4663
Mailing Address - Street 1:4900 HWY 55
Mailing Address - Street 2:SUITE 190
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-544-4663
Mailing Address - Fax:919-544-6427
Practice Address - Street 1:4900 HWY 55
Practice Address - Street 2:SUITE 190
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-544-4663
Practice Address - Fax:919-544-6427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2808261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
U67961Medicare UPIN