Provider Demographics
NPI:1790978740
Name:HEALTHSTARR CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:HEALTHSTARR CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-655-0944
Mailing Address - Street 1:20700 N MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20700 N MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8431
Practice Address - Country:US
Practice Address - Phone:704-655-0944
Practice Address - Fax:704-655-2585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3076111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085JPOtherBCBS
NC1790978740OtherGROUP NPI
NC62871OtherACN
NC89085JPMedicaid
NC1225056740OtherINDIVIDUAL NPI
NC085JPOtherBCBS
NC1225056740OtherINDIVIDUAL NPI