Provider Demographics
NPI:1407976590
Name:EDGECOMBE CHIROPRACTIC INC
Entity type:Organization
Organization Name:EDGECOMBE CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-823-5444
Mailing Address - Street 1:1801 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886
Mailing Address - Country:US
Mailing Address - Phone:252-823-5444
Mailing Address - Fax:252-823-4370
Practice Address - Street 1:1801 MAIN STREET
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886
Practice Address - Country:US
Practice Address - Phone:252-823-5444
Practice Address - Fax:252-823-4370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3396111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2344816Medicare PIN
V10966Medicare UPIN