Provider Demographics
NPI:1992910285
Name:ISLE OF SKY CHIROPRACTIC
Entity type:Organization
Organization Name:ISLE OF SKY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-687-1151
Mailing Address - Street 1:2115 BUTLER BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8730
Mailing Address - Country:US
Mailing Address - Phone:828-687-1151
Mailing Address - Fax:828-687-1102
Practice Address - Street 1:2115 BUTLER BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8730
Practice Address - Country:US
Practice Address - Phone:828-687-1151
Practice Address - Fax:828-687-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3145111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085MEOtherBCBS NC
NC89085MEMedicaid
NC89085MEMedicaid
NC2341507Medicare PIN