Provider Demographics
NPI:1447595699
Name:MOREHEAD CITY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:MOREHEAD CITY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:RACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-247-0112
Mailing Address - Street 1:4050 ARENDELL ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-2977
Mailing Address - Country:US
Mailing Address - Phone:252-247-0112
Mailing Address - Fax:252-247-0118
Practice Address - Street 1:4050 ARENDELL ST
Practice Address - Street 2:SUITE D
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-2977
Practice Address - Country:US
Practice Address - Phone:252-247-0112
Practice Address - Fax:252-247-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910883Medicaid
NC2456100Medicare PIN