Provider Demographics
NPI:1538265384
Name:AMMONS CHIROPRACTIC PC
Entity type:Organization
Organization Name:AMMONS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:AMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-774-6111
Mailing Address - Street 1:1401 GREENWAY CT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-6954
Mailing Address - Country:US
Mailing Address - Phone:919-774-6111
Mailing Address - Fax:919-774-9587
Practice Address - Street 1:1401 GREENWAY CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6954
Practice Address - Country:US
Practice Address - Phone:919-774-6111
Practice Address - Fax:919-774-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1154111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC244300BMedicare PIN
NCT64360Medicare UPIN