Provider Demographics
NPI:1801832811
Name:LAKE NORMAN CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:LAKE NORMAN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:FULTON
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:704-664-3455
Mailing Address - Street 1:612 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-2312
Mailing Address - Country:US
Mailing Address - Phone:704-664-3455
Mailing Address - Fax:704-664-2827
Practice Address - Street 1:612 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2312
Practice Address - Country:US
Practice Address - Phone:704-664-3455
Practice Address - Fax:704-664-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085A6OtherBCBS INDIVIDUAL
NC42162996OtherWAUSAU
NC617420OtherACN
NC53164OtherAWHN
NC350053151OtherRAILROAD MEDICARE
NC7741266OtherAETNA
NC0194LOtherCNC (BCBS)
NC208640OtherQUAILCHOICE
NC43954OtherPARTNERS INDIVIDUAL
NC4881OtherPARTNERS GROUP
NC5909823002OtherCIGNA PAL
NC89085A6Medicaid
NC89085A6Medicaid
NC208640OtherQUAILCHOICE
NC4881OtherPARTNERS GROUP
NC89085A6Medicaid