Provider Demographics
NPI:1386076693
Name:CAROLINA CHIROPRACTIC CENTER P A
Entity type:Organization
Organization Name:CAROLINA CHIROPRACTIC CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCKEEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-855-6316
Mailing Address - Street 1:2007 W VANDALIA RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7617
Mailing Address - Country:US
Mailing Address - Phone:336-855-6316
Mailing Address - Fax:
Practice Address - Street 1:2007 W VANDALIA RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7617
Practice Address - Country:US
Practice Address - Phone:336-855-6316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1107302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244290Medicare UPIN