Provider Demographics
NPI:1366525149
Name:VARDY CHIROPRACTIC AND WELLNESS CLINICS
Entity type:Organization
Organization Name:VARDY CHIROPRACTIC AND WELLNESS CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:VARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-366-3111
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-0092
Mailing Address - Country:US
Mailing Address - Phone:919-366-3111
Mailing Address - Fax:919-366-3366
Practice Address - Street 1:2825 WENDELL BLVD.
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591
Practice Address - Country:US
Practice Address - Phone:919-366-3111
Practice Address - Fax:919-366-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017N6OtherBCBS GROUP #
NC2347804Medicare ID - Type UnspecifiedMEDICARE GROUP #