Organization
CLEMMONS VILLAGE CHIROPRACTIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN RICCOBONI DC (OWNER)
(336) 766-5935
Entity
Organization
Contact information
Practice address
2235 LEWISVILLE CLEMMONS RD, SUITE B, CLEMMONS, NC 27012-8999
(336) 766-5935
Mailing address
2235 LEWISVILLE CLEMMONS RD, SUITE B, CLEMMONS, NC 27012-8999
(336) 766-5935
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3062
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085HM
BLUE CROSS BLUE SHIELD
NC
05
—
89085HM
—
NC
Enumeration date
11/29/2006
Last updated
08/22/2020
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