Provider Demographics
NPI:1528398286
Name:CHISHOLM CHIROPRACTIC CENTER P A
Entity Type:Organization
Organization Name:CHISHOLM CHIROPRACTIC CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-829-5757
Mailing Address - Street 1:605 HILLSBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1731
Mailing Address - Country:US
Mailing Address - Phone:919-829-5757
Mailing Address - Fax:919-829-5808
Practice Address - Street 1:605 HILLSBOROUGH ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1731
Practice Address - Country:US
Practice Address - Phone:919-829-5757
Practice Address - Fax:919-829-5808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2063261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890822BMedicaid
NC890220VMedicaid
NC890822BMedicaid