Provider Demographics
NPI:1710706163
Name:RADICAL CHANGE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:RADICAL CHANGE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SINIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCPHAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-521-3890
Mailing Address - Street 1:316 FRANCES PL
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-2902
Mailing Address - Country:US
Mailing Address - Phone:252-521-3890
Mailing Address - Fax:
Practice Address - Street 1:408 N HERRITAGE ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4304
Practice Address - Country:US
Practice Address - Phone:252-521-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty