Provider Demographics
NPI:1669578332
Name:COMPREHENSIVE CHIROPRACTIC CENTER, P.A.
Entity type:Organization
Organization Name:COMPREHENSIVE CHIROPRACTIC CENTER, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:ASHER
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-467-7797
Mailing Address - Street 1:1125 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4566
Mailing Address - Country:US
Mailing Address - Phone:919-467-7797
Mailing Address - Fax:919-467-9272
Practice Address - Street 1:1125 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4566
Practice Address - Country:US
Practice Address - Phone:919-467-7797
Practice Address - Fax:919-467-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1714111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890195MMedicaid
NC1982645552OtherINDIVIDUAL TYPE 1 NPI #
NC7908541Medicaid
NC2446226Medicare ID - Type Unspecified
NCT90188Medicare UPIN