Provider Demographics
NPI:1497702831
Name:HIRSCH CHIROPRACTIC & WELLNESS CLINIC, INC.
Entity Type:Organization
Organization Name:HIRSCH CHIROPRACTIC & WELLNESS CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HIRSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-569-1567
Mailing Address - Street 1:2125 N SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-7452
Mailing Address - Country:US
Mailing Address - Phone:704-569-1567
Mailing Address - Fax:704-532-0557
Practice Address - Street 1:2125 N SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-7452
Practice Address - Country:US
Practice Address - Phone:704-569-1567
Practice Address - Fax:704-532-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2245111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0837FOtherBCBS
NC890837FMedicaid
NC2345530Medicare ID - Type Unspecified
NC890837FMedicaid