Provider Demographics
NPI:1063587657
Name:CHIROPRACTIC REHABILITATION ACCIDENT AND INJURY CENTER, PLLC
Entity type:Organization
Organization Name:CHIROPRACTIC REHABILITATION ACCIDENT AND INJURY CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SCANLAN
Authorized Official - Last Name:SACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-754-8181
Mailing Address - Street 1:228B MORGANTON BLVD SW
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-5219
Mailing Address - Country:US
Mailing Address - Phone:828-754-8181
Mailing Address - Fax:828-754-8140
Practice Address - Street 1:228B MORGANTON BLVD SW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5219
Practice Address - Country:US
Practice Address - Phone:828-754-8181
Practice Address - Fax:828-754-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890828QMedicaid
NCU4414Medicare UPIN
NC2451561BMedicare ID - Type Unspecified