Provider Demographics
NPI:1609898782
Name:MARS HILL CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:MARS HILL CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-689-3777
Mailing Address - Street 1:PO BOX 1990
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-1990
Mailing Address - Country:US
Mailing Address - Phone:828-689-3777
Mailing Address - Fax:828-689-5435
Practice Address - Street 1:342 CARL ELLER RD.
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:NC
Practice Address - Zip Code:28754
Practice Address - Country:US
Practice Address - Phone:828-689-3777
Practice Address - Fax:828-678-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1419111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08430OtherBC/BS
NC8908339Medicaid
NC8908430Medicaid
NC08339OtherBC/BS
NC8908430Medicaid
NCT64457Medicare UPIN
NC8908339Medicaid
NC08430OtherBC/BS