Provider Demographics
NPI:1821183534
Name:KEVIN DIBELLA, P.C.
Entity Type:Organization
Organization Name:KEVIN DIBELLA, P.C.
Other - Org Name:DIBELLA CHIROPRACTIC CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:SNYDER
Authorized Official - Last Name:DIBELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-867-1010
Mailing Address - Street 1:528 UNION RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4450
Mailing Address - Country:US
Mailing Address - Phone:704-867-1010
Mailing Address - Fax:704-868-2602
Practice Address - Street 1:528 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4450
Practice Address - Country:US
Practice Address - Phone:704-867-1010
Practice Address - Fax:704-868-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001315013111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890282PMedicaid
NC890282PMedicaid
NC2453037Medicare ID - Type Unspecified