Provider Demographics
NPI:1659541076
Name:ERESE CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:ERESE CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-636-0741
Mailing Address - Street 1:1122 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-3614
Mailing Address - Country:US
Mailing Address - Phone:704-636-0741
Mailing Address - Fax:704-636-0793
Practice Address - Street 1:1122 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-3614
Practice Address - Country:US
Practice Address - Phone:704-636-0741
Practice Address - Fax:704-636-0793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2655111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085CEMedicaid
NC89085CEMedicaid
NC2456171Medicare PIN