Provider Demographics
NPI:1962483529
Name:SUMMERFIELD FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:SUMMERFIELD FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROD
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-644-1112
Mailing Address - Street 1:4523 US HIGHWAY 220 N
Mailing Address - Street 2:PO BOX 683
Mailing Address - City:SUMMERFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27358-9412
Mailing Address - Country:US
Mailing Address - Phone:336-644-1112
Mailing Address - Fax:336-644-1118
Practice Address - Street 1:4523 US HIGHWAY 220 N
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:NC
Practice Address - Zip Code:27358-9412
Practice Address - Country:US
Practice Address - Phone:336-644-1112
Practice Address - Fax:336-644-1118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2482111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0830NOtherBCBS OF NC
NC890830NMedicaid
NC0830NOtherBCBS OF NC
NCU68824Medicare UPIN
NC890830NMedicaid