Provider Demographics
NPI:1285730697
Name:MT. OLIVE CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:MT. OLIVE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTAMED
Authorized Official - Suffix:
Authorized Official - Credentials:DC, FASA
Authorized Official - Phone:919-658-0003
Mailing Address - Street 1:515 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-1903
Mailing Address - Country:US
Mailing Address - Phone:919-658-0003
Mailing Address - Fax:919-658-0310
Practice Address - Street 1:515 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-1903
Practice Address - Country:US
Practice Address - Phone:919-658-0003
Practice Address - Fax:919-658-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0820MOtherBLUE CROSS
NC0820MOtherBLUE SHIELD
NC890820MMedicaid
NC890820MMedicaid
NCU65772Medicare UPIN