Provider Demographics
NPI:1356619654
Name:DIRKS CHIROPRACTIC INC
Entity type:Organization
Organization Name:DIRKS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DIRKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-362-0189
Mailing Address - Street 1:360 CHERRY RUN CTR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-4173
Mailing Address - Country:US
Mailing Address - Phone:252-362-0189
Mailing Address - Fax:252-495-0032
Practice Address - Street 1:360 CHERRY RUN CTR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-4173
Practice Address - Country:US
Practice Address - Phone:252-362-0189
Practice Address - Fax:252-495-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2267111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty