Provider Demographics
NPI:1457627861
Name:DOMINIQUE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:DOMINIQUE CHIROPRACTIC, INC.
Other - Org Name:ALPINE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:DOMINIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-433-1071
Mailing Address - Street 1:205 CARBON CITY RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655
Mailing Address - Country:US
Mailing Address - Phone:828-433-1071
Mailing Address - Fax:828-433-9072
Practice Address - Street 1:205 CARBON CITY RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4238
Practice Address - Country:US
Practice Address - Phone:828-433-1071
Practice Address - Fax:828-433-9072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3971111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty