Provider Demographics
NPI:1689991721
Name:26BLACKLLC
Entity Type:Organization
Organization Name:26BLACKLLC
Other - Org Name:TRIANGLE SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING & INSURANCE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CURTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-238-5040
Mailing Address - Street 1:7841 ALEXANDER PROMENADE PL
Mailing Address - Street 2:SUITE #120
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-1913
Mailing Address - Country:US
Mailing Address - Phone:919-357-3600
Mailing Address - Fax:919-357-3800
Practice Address - Street 1:7841 ALEXANDER PROMENADE PL
Practice Address - Street 2:SUITE #120
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-1913
Practice Address - Country:US
Practice Address - Phone:919-357-3600
Practice Address - Fax:919-357-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2457280Medicare UPIN