Provider Demographics
NPI:1578808077
Name:SWANSBORO CHIROPRACTIC
Entity Type:Organization
Organization Name:SWANSBORO CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BODIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DORRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-325-3670
Mailing Address - Street 1:923 W CORBETT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-9530
Mailing Address - Country:US
Mailing Address - Phone:910-325-3670
Mailing Address - Fax:910-325-3680
Practice Address - Street 1:923 W CORBETT AVE STE 2
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-9530
Practice Address - Country:US
Practice Address - Phone:910-325-3670
Practice Address - Fax:910-325-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890838HMedicaid