Provider Demographics
NPI:1295353944
Name:BSD CHIRO
Entity type:Organization
Organization Name:BSD CHIRO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:JOELL
Authorized Official - Last Name:KENNEDY MAULTSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-430-2322
Mailing Address - Street 1:310 PETE JONES DR
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:NC
Mailing Address - Zip Code:28574-8180
Mailing Address - Country:US
Mailing Address - Phone:910-430-2322
Mailing Address - Fax:
Practice Address - Street 1:310 PETE JONES DR
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:NC
Practice Address - Zip Code:28574-8180
Practice Address - Country:US
Practice Address - Phone:910-430-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty