Provider Demographics
NPI:1295119782
Name:CLEVELAND CHIROPRACTIC AND MASSAGE PLLC
Entity type:Organization
Organization Name:CLEVELAND CHIROPRACTIC AND MASSAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-550-9355
Mailing Address - Street 1:5638 NC 42 W
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529
Mailing Address - Country:US
Mailing Address - Phone:919-772-7996
Mailing Address - Fax:
Practice Address - Street 1:5638 NC 42 W
Practice Address - Street 2:SUITE 204
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-5638
Practice Address - Country:US
Practice Address - Phone:919-772-7996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty