Provider Demographics
NPI:1538238720
Name:ASHFORTH CHIROPRACTIC FAMILY WELLNESS CENTER
Entity type:Organization
Organization Name:ASHFORTH CHIROPRACTIC FAMILY WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASHFORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-844-6560
Mailing Address - Street 1:8340 BANDFORD WAY STE 109
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2755
Mailing Address - Country:US
Mailing Address - Phone:919-844-6560
Mailing Address - Fax:919-844-6590
Practice Address - Street 1:8340 BANDFORD WAY STE 109
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2755
Practice Address - Country:US
Practice Address - Phone:919-844-6560
Practice Address - Fax:919-844-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890833TMedicaid
NC2452753AMedicare ID - Type Unspecified