Provider Demographics
NPI:1427072719
Name:NEVILLE, WANDA JO (DC)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:JO
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510
Mailing Address - Country:US
Mailing Address - Phone:919-967-7887
Mailing Address - Fax:919-968-7294
Practice Address - Street 1:505 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510
Practice Address - Country:US
Practice Address - Phone:919-967-7887
Practice Address - Fax:919-968-7294
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244566Medicare ID - Type Unspecified
T97106Medicare UPIN