Provider Demographics
NPI:1316243041
Name:SOURCE FOR CHIROPRACTIC, INCORPORATED
Entity type:Organization
Organization Name:SOURCE FOR CHIROPRACTIC, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRAZIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-280-3100
Mailing Address - Street 1:114 MONTREAT RD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-3116
Mailing Address - Country:US
Mailing Address - Phone:828-280-3100
Mailing Address - Fax:
Practice Address - Street 1:114 MONTREAT RD
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3116
Practice Address - Country:US
Practice Address - Phone:828-280-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty