Provider Demographics
NPI:1659533818
Name:FAMILY WELLNESS CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:FAMILY WELLNESS CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:FOSTER
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-872-1130
Mailing Address - Street 1:4229 LOUISBURG RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-4345
Mailing Address - Country:US
Mailing Address - Phone:919-872-1130
Mailing Address - Fax:919-872-1125
Practice Address - Street 1:4229 LOUISBURG RD STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-4345
Practice Address - Country:US
Practice Address - Phone:919-872-1130
Practice Address - Fax:919-872-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2535111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7908255Medicaid
NCU80082Medicare UPIN
NC2452607Medicare PIN