Provider Demographics
NPI:1508197500
Name:SRCDC INC
Entity Type:Organization
Organization Name:SRCDC INC
Other - Org Name:LUMBERTON CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:910-738-3600
Mailing Address - Street 1:4914 FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2110
Mailing Address - Country:US
Mailing Address - Phone:910-738-3600
Mailing Address - Fax:910-671-9385
Practice Address - Street 1:4914 FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2110
Practice Address - Country:US
Practice Address - Phone:910-738-3600
Practice Address - Fax:910-671-9385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty