Provider Demographics
NPI:1124060686
Name:HARRISBURG CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:HARRISBURG CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-455-2211
Mailing Address - Street 1:12020 UNIVERSITY CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8466
Mailing Address - Country:US
Mailing Address - Phone:704-455-2211
Mailing Address - Fax:704-455-8246
Practice Address - Street 1:12020 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8466
Practice Address - Country:US
Practice Address - Phone:704-455-2211
Practice Address - Fax:704-455-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001183349111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085AGOtherBLUE CROSS BLUE SHIELD NC
NC89085AGMedicaid
NC085AGOtherBLUE CROSS BLUE SHIELD NC
NCU84187Medicare UPIN