Provider Demographics
NPI:1023115474
Name:SHAVER CHIROPRACTIC
Entity type:Organization
Organization Name:SHAVER CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC DICCP
Authorized Official - Phone:910-452-5555
Mailing Address - Street 1:4421 JUNCTION PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2263
Mailing Address - Country:US
Mailing Address - Phone:910-452-5555
Mailing Address - Fax:910-452-5044
Practice Address - Street 1:4421 JUNCTION PARK DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2263
Practice Address - Country:US
Practice Address - Phone:910-452-5555
Practice Address - Fax:910-452-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1781111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2446941AOtherMEDICARE INDIVIDUAL PROVIDER PTAN
NC890877BMedicaid
NC0877BOtherBCBS
NC2446941BOtherMEDICARE GROUP PROVIDER PTAN
NC2446941BOtherMEDICARE GROUP PROVIDER PTAN