Provider Demographics
NPI:1013977131
Name:GILEAD CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:GILEAD CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINA
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:704-399-3794
Mailing Address - Street 1:PO BOX 19052
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9052
Mailing Address - Country:US
Mailing Address - Phone:704-399-3794
Mailing Address - Fax:704-697-9812
Practice Address - Street 1:3000 BEATTIES FORD RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-3732
Practice Address - Country:US
Practice Address - Phone:704-399-3794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085TROtherBCBS STATE PLAN