Provider Demographics
NPI:1013076785
Name:YADKINVILLE CHIROPRACTIC DC PA
Entity type:Organization
Organization Name:YADKINVILLE CHIROPRACTIC DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-679-8500
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055
Mailing Address - Country:US
Mailing Address - Phone:336-679-8500
Mailing Address - Fax:336-677-8536
Practice Address - Street 1:204 N STATE ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055
Practice Address - Country:US
Practice Address - Phone:336-679-8500
Practice Address - Fax:336-677-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085C4Medicaid
NC2454180Medicare ID - Type Unspecified