Individual
Inactive
Sole proprietor
Provider details
NPI number
Contact information
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
544
SC
111N00000X
Chiropractor
Primary
655
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08276
BCBS
NC
01
—
36568925
STATE
NC
05
—
8908276
—
NC
Enumeration date
—
Last updated
—
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