Provider Demographics
NPI:1548232002
Name:BACK SOLUTIONS CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:BACK SOLUTIONS CHIROPRACTIC CENTER PLLC
Other - Org Name:MINDY H BRADSHAW DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:HALL
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-969-0931
Mailing Address - Street 1:11312 US HWY 15 501 N
Mailing Address - Street 2:STE 104
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-6377
Mailing Address - Country:US
Mailing Address - Phone:919-969-0931
Mailing Address - Fax:919-969-0933
Practice Address - Street 1:11312 US HWY 15 501 N
Practice Address - Street 2:STE 104
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-6377
Practice Address - Country:US
Practice Address - Phone:919-969-0931
Practice Address - Fax:919-969-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900355Medicaid
NC085VCOtherBCBS
NC085VCOtherBCBS
NC2457932Medicare ID - Type Unspecified