Provider Demographics
NPI:1992857155
Name:JP CHIROPRACTIC & POSTURE, LLC
Entity Type:Organization
Organization Name:JP CHIROPRACTIC & POSTURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEONGPIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-841-1701
Mailing Address - Street 1:101 E MATTHEWS ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-4866
Mailing Address - Country:US
Mailing Address - Phone:704-841-1701
Mailing Address - Fax:704-841-1596
Practice Address - Street 1:101 E MATTHEWS ST
Practice Address - Street 2:SUITE 700
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-4866
Practice Address - Country:US
Practice Address - Phone:704-841-1701
Practice Address - Fax:704-841-1596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3352111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902382Medicaid
NC5902382Medicaid
NC2458023Medicare ID - Type Unspecified