Provider Demographics
NPI:1356566830
Name:CHANDLER CHIROPRACTIC CENTER, P.A.
Entity type:Organization
Organization Name:CHANDLER CHIROPRACTIC CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-845-8499
Mailing Address - Street 1:PO BOX 835
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-0835
Mailing Address - Country:US
Mailing Address - Phone:704-845-8499
Mailing Address - Fax:704-845-5321
Practice Address - Street 1:1340 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5580
Practice Address - Country:US
Practice Address - Phone:704-845-8499
Practice Address - Fax:704-845-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1517 AND 2845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCT64511Medicare UPIN
NC244491AMedicare ID - Type UnspecifiedMEDICARE ID
NC2454069Medicare ID - Type Unspecified