Provider Demographics
NPI:1790919637
Name:CHAVIS CHIROPRACTIC CLINIC OF MONROE, P.A.
Entity Type:Organization
Organization Name:CHAVIS CHIROPRACTIC CLINIC OF MONROE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-283-5599
Mailing Address - Street 1:2204 W ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2762
Mailing Address - Country:US
Mailing Address - Phone:704-283-5599
Mailing Address - Fax:704-282-0317
Practice Address - Street 1:1518 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-5749
Practice Address - Country:US
Practice Address - Phone:704-628-0378
Practice Address - Fax:704-282-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3103261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085M6OtherBLUE CROSS/BLUE SHIELD
NC2455493BOtherMEDICARE
NC89085M6Medicaid
NC2455493CMedicare PIN