Provider Demographics
NPI:1184720302
Name:SUNSET RIDGE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:SUNSET RIDGE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:POPOW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-577-3974
Mailing Address - Street 1:1100 HOLLY SPRINGS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-9469
Mailing Address - Country:US
Mailing Address - Phone:919-577-3974
Mailing Address - Fax:919-577-6351
Practice Address - Street 1:1100 HOLLY SPRINGS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-9469
Practice Address - Country:US
Practice Address - Phone:919-577-3974
Practice Address - Fax:919-577-6351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015X0Medicaid
NC015X0OtherBC/ BS GROUP NUMBER
NC=========OtherALL OTHER INSURANCE GROUP
NC2338811Medicare ID - Type UnspecifiedSUNSET RIDGE CHIROPRACTIC