Provider Demographics
NPI:1700395167
Name:DOMINIQUE NATURAL HEALTH INC.
Entity Type:Organization
Organization Name:DOMINIQUE NATURAL HEALTH INC.
Other - Org Name:HOLISTIC MEDICAL CLINIC OF THE CAROLINAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-667-6464
Mailing Address - Street 1:308 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2504
Mailing Address - Country:US
Mailing Address - Phone:336-667-6464
Mailing Address - Fax:336-667-4488
Practice Address - Street 1:308 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2504
Practice Address - Country:US
Practice Address - Phone:336-667-6464
Practice Address - Fax:336-667-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3951111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty