Provider Demographics
NPI:1659430676
Name:RENO CHIROPRACTIC CENTER, P.A.
Entity Type:Organization
Organization Name:RENO CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:GRIGSTON
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-480-1700
Mailing Address - Street 1:210 E GROVER ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3918
Mailing Address - Country:US
Mailing Address - Phone:704-480-1700
Mailing Address - Fax:704-480-1708
Practice Address - Street 1:210 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3918
Practice Address - Country:US
Practice Address - Phone:704-480-1700
Practice Address - Fax:704-480-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1798111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890875BMedicaid
NC2450609AMedicare ID - Type Unspecified
U19942Medicare UPIN