Provider Demographics
NPI:1497924021
Name:ADJUST EXPERIENCE CHIROPRACTIC, P. A.
Entity Type:Organization
Organization Name:ADJUST EXPERIENCE CHIROPRACTIC, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:COSIMO
Authorized Official - Last Name:DANIELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-480-1111
Mailing Address - Street 1:439 WESTWOOD SHOPPING CTR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1532
Mailing Address - Country:US
Mailing Address - Phone:910-480-1111
Mailing Address - Fax:910-480-1113
Practice Address - Street 1:1905 SKIBO RD
Practice Address - Street 2:SUITE 103
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1518
Practice Address - Country:US
Practice Address - Phone:910-480-1111
Practice Address - Fax:910-480-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3330111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085UXMedicaid
NC085UXOtherBLUE CROSS/BLUE SHIELD
NCU91086OtherUPIN
NC89085UXMedicaid