Provider Demographics
NPI:1679678171
Name:SOUTH MAIN CHIROPRACTIC OF LEXINGTON, PLLC
Entity Type:Organization
Organization Name:SOUTH MAIN CHIROPRACTIC OF LEXINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-243-8000
Mailing Address - Street 1:813 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3150
Mailing Address - Country:US
Mailing Address - Phone:336-243-8000
Mailing Address - Fax:336-243-8001
Practice Address - Street 1:813 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3150
Practice Address - Country:US
Practice Address - Phone:336-243-8000
Practice Address - Fax:336-243-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2779261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center