Provider Demographics
NPI:1609976497
Name:CONOVER CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:CONOVER CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:KEARNS
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:828-464-7791
Mailing Address - Street 1:408 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-2704
Mailing Address - Country:US
Mailing Address - Phone:828-464-7791
Mailing Address - Fax:828-465-4062
Practice Address - Street 1:408 1ST AVE S
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2704
Practice Address - Country:US
Practice Address - Phone:828-464-7791
Practice Address - Fax:828-465-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1387111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08341OtherBLUE CROSS
NC8908341Medicaid
NC1609976497Medicaid
NCT64442Medicare UPIN
NC2347482Medicare PIN