Provider Demographics
NPI:1770631707
Name:BURCH CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:BURCH CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-694-6585
Mailing Address - Street 1:308 E CASWELL ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2243
Mailing Address - Country:US
Mailing Address - Phone:704-694-6585
Mailing Address - Fax:704-694-6587
Practice Address - Street 1:308 E CASWELL ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2243
Practice Address - Country:US
Practice Address - Phone:704-694-6585
Practice Address - Fax:704-694-6587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0833YOtherBCBS PROVIDER NUMBER
NC890833YMedicaid
NYP00106156OtherRAILROAD MEDICARE PROV #
NC069906Medicare UPIN
NYP00106156OtherRAILROAD MEDICARE PROV #