Provider Demographics
NPI:1972676013
Name:DORRANCE CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:DORRANCE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BODIE
Authorized Official - Middle Name:ROYAL
Authorized Official - Last Name:DORRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-431-1700
Mailing Address - Street 1:820 S GARNETT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536
Mailing Address - Country:US
Mailing Address - Phone:252-431-1700
Mailing Address - Fax:252-431-1473
Practice Address - Street 1:820 S GARNETT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536
Practice Address - Country:US
Practice Address - Phone:252-431-1700
Practice Address - Fax:252-431-1473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013KFMedicaid
NC2450526AMedicare PIN
U62461Medicare UPIN