Provider Demographics
NPI:1902975865
Name:PINEHURST CHIROPRACTIC INC
Entity Type:Organization
Organization Name:PINEHURST CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:CLEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC , ART
Authorized Official - Phone:910-295-1215
Mailing Address - Street 1:5 REGIONAL CIR STE C
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-9796
Mailing Address - Country:US
Mailing Address - Phone:910-295-1215
Mailing Address - Fax:910-295-1814
Practice Address - Street 1:5 REGIONAL CIR STE C
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9796
Practice Address - Country:US
Practice Address - Phone:910-295-1215
Practice Address - Fax:910-295-1814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3442111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903101Medicaid
NC5903101Medicaid
NC2458656Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUM
NCV 08994Medicare UPIN