Provider Demographics
NPI:1760802110
Name:EAGLE CHIROPRACTIC FAMILY WELLNESS CENTER P A
Entity Type:Organization
Organization Name:EAGLE CHIROPRACTIC FAMILY WELLNESS CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:828-668-1032
Mailing Address - Street 1:PO BOX 1651
Mailing Address - Street 2:
Mailing Address - City:OLD FORT
Mailing Address - State:NC
Mailing Address - Zip Code:28762-1651
Mailing Address - Country:US
Mailing Address - Phone:828-668-1032
Mailing Address - Fax:828-668-1032
Practice Address - Street 1:262 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:OLD FORT
Practice Address - State:NC
Practice Address - Zip Code:28762
Practice Address - Country:US
Practice Address - Phone:828-668-1032
Practice Address - Fax:828-668-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU63237Medicare UPIN