Provider Demographics
NPI:1205172756
Name:COLES CHIROPRACTIC CENTER, PLLC
Entity type:Organization
Organization Name:COLES CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLES
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:252-571-1573
Mailing Address - Street 1:218C S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-2136
Mailing Address - Country:US
Mailing Address - Phone:252-514-0092
Mailing Address - Fax:855-256-2336
Practice Address - Street 1:107 DURWOOD CT
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2274
Practice Address - Country:US
Practice Address - Phone:252-571-1573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCG371D188OtherMEDICARE PTAN
NCD188OtherMEDICARE GROUP PTAN