Provider Demographics
NPI:1295272631
Name:IMPACT FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:IMPACT FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:VANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-423-0623
Mailing Address - Street 1:620 VETERANS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520
Mailing Address - Country:US
Mailing Address - Phone:919-977-5744
Mailing Address - Fax:919-977-6320
Practice Address - Street 1:620 VETERANS PARKWAY
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5803
Practice Address - Country:US
Practice Address - Phone:919-423-0623
Practice Address - Fax:919-977-6320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-24
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4197111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG655Medicare PIN