Provider Demographics
NPI:1356398838
Name:RALEIGH ACCIDENT & INJURY CENTER
Entity type:Organization
Organization Name:RALEIGH ACCIDENT & INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:SALETNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-250-3330
Mailing Address - Street 1:1620 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610
Mailing Address - Country:US
Mailing Address - Phone:919-250-3330
Mailing Address - Fax:919-250-9995
Practice Address - Street 1:1620 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610
Practice Address - Country:US
Practice Address - Phone:919-250-3330
Practice Address - Fax:919-250-9995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8085N1OtherBLUE CROSS BLUE SHIELD
NC89085N1Medicaid
NC89085N1Medicare ID - Type Unspecified
NC89085N1Medicaid