Provider Demographics
NPI:1720155138
Name:MAIDEN FAMILY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:MAIDEN FAMILY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CLINE-GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-428-5656
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-0245
Mailing Address - Country:US
Mailing Address - Phone:828-428-5656
Mailing Address - Fax:
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MAIDEN
Practice Address - State:NC
Practice Address - Zip Code:28650-1419
Practice Address - Country:US
Practice Address - Phone:828-428-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456108Medicare ID - Type Unspecified