Provider Demographics
NPI:1750344644
Name:SOUTHEASTERN HEALTHCARE CENTERS PC
Entity type:Organization
Organization Name:SOUTHEASTERN HEALTHCARE CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:V
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-754-9000
Mailing Address - Street 1:4501 MAIN ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4589
Mailing Address - Country:US
Mailing Address - Phone:910-754-9000
Mailing Address - Fax:910-754-9080
Practice Address - Street 1:4501 MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4589
Practice Address - Country:US
Practice Address - Phone:910-754-9000
Practice Address - Fax:910-754-9080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEASTERN HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-11
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty