Provider Demographics
NPI:1306980636
Name:BLUE RIDGE CHIROPRACTIC CLINIC PA
Entity type:Organization
Organization Name:BLUE RIDGE CHIROPRACTIC CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BOONE
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-652-5321
Mailing Address - Street 1:387 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4526
Mailing Address - Country:US
Mailing Address - Phone:828-652-5321
Mailing Address - Fax:828-652-2318
Practice Address - Street 1:387 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4526
Practice Address - Country:US
Practice Address - Phone:828-652-5321
Practice Address - Fax:828-652-2318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1760111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164475356Medicare ID - Type Unspecified