Provider Demographics
NPI:1558303131
Name:LOUISBURG CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:LOUISBURG CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-496-4664
Mailing Address - Street 1:1165 US 401 HWY S
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549
Mailing Address - Country:US
Mailing Address - Phone:919-496-4664
Mailing Address - Fax:919-496-7930
Practice Address - Street 1:1165 US 401 HWY S
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549
Practice Address - Country:US
Practice Address - Phone:919-496-4664
Practice Address - Fax:919-496-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1470111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5737144OtherAETNA
NC08972OtherBCBS
NC8908972Medicaid
NC8908972Medicaid
NC2448774Medicare ID - Type UnspecifiedGRP
NC08972OtherBCBS