Provider Demographics
NPI:1639277536
Name:CONCORD FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:CONCORD FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDAENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-795-1000
Mailing Address - Street 1:810 CHURCH ST N
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-4338
Mailing Address - Country:US
Mailing Address - Phone:704-795-1000
Mailing Address - Fax:704-795-1040
Practice Address - Street 1:810 CHURCH ST N
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-4338
Practice Address - Country:US
Practice Address - Phone:704-795-1000
Practice Address - Fax:704-795-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2652267OtherAETNA HMO
NC8908444Medicaid
NC7001301OtherAETNA PPO
NC0844UOtherBCBS
NC2458582Medicare ID - Type Unspecified
NC7001301OtherAETNA PPO