Provider Demographics
NPI:1659478998
Name:MUDRYK FAMILY CHIROPRACTIC, PA
Entity type:Organization
Organization Name:MUDRYK FAMILY CHIROPRACTIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:REED
Authorized Official - Last Name:MUDRYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-387-7220
Mailing Address - Street 1:539 KEISLER DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9320
Mailing Address - Country:US
Mailing Address - Phone:919-387-7220
Mailing Address - Fax:919-387-8121
Practice Address - Street 1:539 KEISLER DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9320
Practice Address - Country:US
Practice Address - Phone:919-387-7220
Practice Address - Fax:919-387-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3203111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085TCOtherBCBS
NC2348665Medicare PIN
NC085TCOtherBCBS