Provider Demographics
NPI:1144326125
Name:NEW HANOVER CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:NEW HANOVER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GENTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-762-1258
Mailing Address - Street 1:2470 DELANEY RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6062
Mailing Address - Country:US
Mailing Address - Phone:910-762-1258
Mailing Address - Fax:910-762-9378
Practice Address - Street 1:2470 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6062
Practice Address - Country:US
Practice Address - Phone:910-762-1258
Practice Address - Fax:910-762-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08676OtherBCBS GROUP
NC7908676Medicaid
NC08676OtherBCBS GROUP
NC7908676Medicaid