Provider Demographics
NPI:1518709146
Name:SUMMIT CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SUMMIT CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-867-1612
Mailing Address - Street 1:6415 BROOKSTONE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0075
Mailing Address - Country:US
Mailing Address - Phone:910-867-1612
Mailing Address - Fax:
Practice Address - Street 1:6415 BROOKSTONE LN STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0075
Practice Address - Country:US
Practice Address - Phone:910-867-1612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty