Provider Demographics
NPI:1265624308
Name:HELMENDACH CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:HELMENDACH CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:HELMENDACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-573-7161
Mailing Address - Street 1:7215 LEBANON RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-9027
Mailing Address - Country:US
Mailing Address - Phone:704-573-7161
Mailing Address - Fax:704-573-3799
Practice Address - Street 1:7215 LEBANON RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-9027
Practice Address - Country:US
Practice Address - Phone:704-573-7161
Practice Address - Fax:704-573-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001351967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08959OtherBCBS
NC1124186200OtherINDIVIDUAL NPI
NC1265624308OtherGROUP NPI
NCCB9849OtherMEDICARE RR
NCU242111Medicare UPIN
NC2338958Medicare PIN
NC2447207AMedicare PIN