Provider Demographics
NPI:1821045071
Name:STROUD CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:STROUD CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:336-434-2107
Mailing Address - Street 1:3204 ARCHDALE RD
Mailing Address - Street 2:
Mailing Address - City:ARCHDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27263-2710
Mailing Address - Country:US
Mailing Address - Phone:336-434-2107
Mailing Address - Fax:336-434-2109
Practice Address - Street 1:3204 ARCHDALE RD
Practice Address - Street 2:
Practice Address - City:ARCHDALE
Practice Address - State:NC
Practice Address - Zip Code:27263-2710
Practice Address - Country:US
Practice Address - Phone:336-434-2107
Practice Address - Fax:336-434-2109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1450111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908824Medicaid
NC244424CMedicare PIN
NC8908824Medicaid