Provider Demographics
NPI:1477653251
Name:CRONIN CHIROPRACTIC AND ACUPUNCTURE CLINIC
Entity Type:Organization
Organization Name:CRONIN CHIROPRACTIC AND ACUPUNCTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-643-3850
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:STOKESDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27357-0506
Mailing Address - Country:US
Mailing Address - Phone:336-643-3850
Mailing Address - Fax:
Practice Address - Street 1:8500 ELLISBORO RD
Practice Address - Street 2:SUITE L
Practice Address - City:STOKESDALE
Practice Address - State:NC
Practice Address - Zip Code:27357-9208
Practice Address - Country:US
Practice Address - Phone:336-643-3850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC915111N00000X, 111NX0800X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1462OtherPARTNERS
NC08321OtherBLUE CROSS
NC08321OtherBLUE SHIELD
NC8908321Medicaid
NC244351Medicare PIN
NC8908321Medicaid