Provider Demographics
NPI:1730355769
Name:LEXINGTON CHIROPRACTIC AND WELLNESS, P.A.
Entity type:Organization
Organization Name:LEXINGTON CHIROPRACTIC AND WELLNESS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:VIRGINIA
Authorized Official - Last Name:TUSSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-248-5200
Mailing Address - Street 1:200 S STATE ST
Mailing Address - Street 2:STE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27292-3373
Mailing Address - Country:US
Mailing Address - Phone:336-248-5200
Mailing Address - Fax:336-249-3200
Practice Address - Street 1:200 S STATE ST
Practice Address - Street 2:STE 1
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3373
Practice Address - Country:US
Practice Address - Phone:336-248-5200
Practice Address - Fax:336-249-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3391111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902167Medicaid
NC086CAOtherBLUE CROSS BLUE SHIELD
NC2458463BMedicare PIN