Provider Demographics
NPI:1972637023
Name:SPINALCARE OF WILMINGTON, PLLC
Entity Type:Organization
Organization Name:SPINALCARE OF WILMINGTON, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-798-5560
Mailing Address - Street 1:4024 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6851
Mailing Address - Country:US
Mailing Address - Phone:910-798-5560
Mailing Address - Fax:910-798-5561
Practice Address - Street 1:4024 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6851
Practice Address - Country:US
Practice Address - Phone:910-798-5560
Practice Address - Fax:910-798-5561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085EYMedicaid
NCU85730Medicare UPIN