Provider Demographics
NPI:1568550911
Name:DABBS, JOHN R JR (DC-CCSP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DABBS
Suffix:JR
Gender:M
Credentials:DC-CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HIGHLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5062
Mailing Address - Country:US
Mailing Address - Phone:336-623-2925
Mailing Address - Fax:336-627-8421
Practice Address - Street 1:405 BOONE RD
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-4967
Practice Address - Country:US
Practice Address - Phone:336-627-7398
Practice Address - Fax:336-627-8421
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2329111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890825QMedicaid