Provider Demographics
NPI:1215955091
Name:WERNESS, CHRISTIAN D (DC)
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:D
Last Name:WERNESS
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 1:4517 LEAD MINE ROAD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3326
Mailing Address - Country:US
Mailing Address - Phone:919-781-8830
Mailing Address - Fax:919-781-1678
Practice Address - Street 1:4517 LEAD MINE ROAD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3326
Practice Address - Country:US
Practice Address - Phone:919-781-8830
Practice Address - Fax:919-781-1678
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085U1OtherBLUE CROSS BLUE SHIELD
NC5900278Medicaid
U66814Medicare UPIN
2457703Medicare ID - Type Unspecified
NC5900278Medicaid