Provider Demographics
NPI:1538518675
Name:CAROLINA CLINIC OF NATURAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:CAROLINA CLINIC OF NATURAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-650-1789
Mailing Address - Street 1:150 PRESTON EXECUTIVE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8485
Mailing Address - Country:US
Mailing Address - Phone:919-650-1789
Mailing Address - Fax:
Practice Address - Street 1:150 PRESTON EXECUTIVE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8485
Practice Address - Country:US
Practice Address - Phone:919-650-1789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty