Provider Demographics
NPI:1558541938
Name:CHATUGE SHORES FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CHATUGE SHORES FAMILY CHIROPRACTIC, PC
Other - Org Name:ADVANCED SPINAL CORRECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-389-1234
Mailing Address - Street 1:1955 NC 69
Mailing Address - Street 2:PO BOX 839
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-7312
Mailing Address - Country:US
Mailing Address - Phone:828-389-1234
Mailing Address - Fax:828-389-0123
Practice Address - Street 1:1955 NC 69
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-7312
Practice Address - Country:US
Practice Address - Phone:828-389-1234
Practice Address - Fax:828-389-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHVMMedicare PIN
GAV01227Medicare UPIN