Provider Demographics
NPI:1710093307
Name:RALEIGH SPECIFIC CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:RALEIGH SPECIFIC CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:WINGET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-846-7004
Mailing Address - Street 1:7721 SIX FORKS RD STE 138
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5014
Mailing Address - Country:US
Mailing Address - Phone:919-846-7004
Mailing Address - Fax:919-846-0320
Practice Address - Street 1:7721 SIX FORKS RD STE 138
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5014
Practice Address - Country:US
Practice Address - Phone:919-846-7004
Practice Address - Fax:919-846-0320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016FOOtherBCBS
NC2341084Medicare ID - Type Unspecified