Provider Demographics
NPI:1831291103
Name:AXELSON CHIROPRACTIC HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:AXELSON CHIROPRACTIC HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:AXELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-745-0334
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:NC
Mailing Address - Zip Code:28509-0126
Mailing Address - Country:US
Mailing Address - Phone:252-745-0334
Mailing Address - Fax:252-745-2234
Practice Address - Street 1:13550 HWY 55 E
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:NC
Practice Address - Zip Code:28509
Practice Address - Country:US
Practice Address - Phone:252-745-0334
Practice Address - Fax:252-745-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890833FTMedicaid
NC0833GOtherBCBS PROVIDER NUMBER
NC350046002OtherRAILROAD MEDICARE NUMBER
NC890833GMedicaid
NC0833GOtherBCBS
NC89085FTMedicaid
NC89085FTMedicaid
NC0833GOtherBCBS PROVIDER NUMBER