Provider Demographics
NPI:1457004616
Name:LILES FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:LILES FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-201-8990
Mailing Address - Street 1:2519 AIRPORT BLVD NW STE F
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9603
Mailing Address - Country:US
Mailing Address - Phone:252-201-8990
Mailing Address - Fax:
Practice Address - Street 1:2519 AIRPORT BLVD NW STE F
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-9603
Practice Address - Country:US
Practice Address - Phone:252-201-8990
Practice Address - Fax:252-201-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty