Provider Demographics
NPI:1770694218
Name:CHILDERS, KIRK A (DC)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:A
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 UNIVERSITY DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-2548
Mailing Address - Country:US
Mailing Address - Phone:919-493-1940
Mailing Address - Fax:919-493-5717
Practice Address - Street 1:4015 UNIVERSITY DR
Practice Address - Street 2:SUITE K
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2548
Practice Address - Country:US
Practice Address - Phone:919-493-1940
Practice Address - Fax:919-493-5717
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2390111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0143ROtherNC BCBS
NC0143ROtherNC BCBS
NC2450920Medicare ID - Type Unspecified