Provider Demographics
NPI:1467532226
Name:ATLANTIC COAST CHIROPRACTIC
Entity Type:Organization
Organization Name:ATLANTIC COAST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GIACALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-798-0101
Mailing Address - Street 1:6841 D MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-7132
Mailing Address - Country:US
Mailing Address - Phone:910-798-0101
Mailing Address - Fax:910-798-0102
Practice Address - Street 1:6841 D MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-7132
Practice Address - Country:US
Practice Address - Phone:910-798-0101
Practice Address - Fax:910-798-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3423111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902802Medicaid
NC6691270001OtherNATIONAL SUPPLIER CLEARINGHOUSE NPI
NC085W9OtherBCBS
NC2458436OtherMEDICARE PTAN
V08140Medicare UPIN