Provider Demographics
NPI:1790858173
Name:BESS CHIROPRACTIC, PA
Entity Type:Organization
Organization Name:BESS CHIROPRACTIC, PA
Other - Org Name:BESS CHIROPRACTIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:BESS-FISHEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-225-1918
Mailing Address - Street 1:813 E ROOSEVELT BLVD STE K
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-5169
Mailing Address - Country:US
Mailing Address - Phone:704-225-1918
Mailing Address - Fax:704-225-9719
Practice Address - Street 1:813 E ROOSEVELT BLVD STE K
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5169
Practice Address - Country:US
Practice Address - Phone:704-225-1918
Practice Address - Fax:704-225-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2325 AND 2358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013WCOtherBCBSNC
NC89013WCMedicaid
NC2455952Medicare PIN
NC2335739Medicare PIN