Provider Demographics
NPI:1013965938
Name:MURPHY, JENNIFER TRACHTE (DC, DICCP)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:TRACHTE
Last Name:MURPHY
Suffix:
Gender:F
Credentials:DC, DICCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PINK HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28572-7986
Mailing Address - Country:US
Mailing Address - Phone:252-568-6400
Mailing Address - Fax:252-568-6461
Practice Address - Street 1:312 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PINK HILL
Practice Address - State:NC
Practice Address - Zip Code:28572-7986
Practice Address - Country:US
Practice Address - Phone:252-568-6400
Practice Address - Fax:252-568-6461
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2356111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890884MMedicaid
NC0884MOtherBC/BS
NC0884MOtherBC/BS
NC2450535Medicare ID - Type Unspecified