Provider Demographics
NPI:1316086366
Name:TEAM CHIROPRACTIC & SPORTS MEDICINE, PA
Entity type:Organization
Organization Name:TEAM CHIROPRACTIC & SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:DODD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-788-8881
Mailing Address - Street 1:309-199 W MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4385
Mailing Address - Country:US
Mailing Address - Phone:919-788-8881
Mailing Address - Fax:919-788-8818
Practice Address - Street 1:309-199 W MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4385
Practice Address - Country:US
Practice Address - Phone:919-788-8881
Practice Address - Fax:919-788-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2172111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2346483OtherMEDICARE GROUP NUMBER
NC7908316Medicaid
NC0201UOtherBCBS GROUP NUMBER
NC08316OtherBCBS INDIVIDUAL DODD
NC790201UOtherMEDICAID GROUP NUMBER
NC790201UOtherMEDICAID GROUP NUMBER