Provider Demographics
NPI:1821277021
Name:WAKE SPINE AND DISC INC
Entity Type:Organization
Organization Name:WAKE SPINE AND DISC INC
Other - Org Name:KNIGHTDALE CHIROPRACTIC, PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:CRITORIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-266-6416
Mailing Address - Street 1:1008A BIG OAK CT
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8841
Mailing Address - Country:US
Mailing Address - Phone:919-266-6416
Mailing Address - Fax:919-266-2128
Practice Address - Street 1:1008A BIG OAK CT
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8841
Practice Address - Country:US
Practice Address - Phone:919-266-6416
Practice Address - Fax:919-266-2128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1531111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1275626764OtherINDIVIDUAL NPI
NC1821277021OtherGROUP MEDICARE NPI
NC8908424Medicaid
NC2349123OtherGROUP MEDICARE PTAN
NC244504AMedicare PIN
NC1821277021OtherGROUP MEDICARE NPI