Provider Demographics
NPI:1730451204
Name:COLUMBUS FAMILY CHIROPRACTIC CENTER PC
Entity type:Organization
Organization Name:COLUMBUS FAMILY CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ERNEST
Authorized Official - Last Name:PREASE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-654-3581
Mailing Address - Street 1:5754 CHADBOURN HWY
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-8434
Mailing Address - Country:US
Mailing Address - Phone:910-654-3581
Mailing Address - Fax:910-654-4999
Practice Address - Street 1:5754 CHADBOURN HWY
Practice Address - Street 2:
Practice Address - City:CHADBOURN
Practice Address - State:NC
Practice Address - Zip Code:28431-8434
Practice Address - Country:US
Practice Address - Phone:910-654-3581
Practice Address - Fax:910-654-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890844WMedicaid
2454048Medicare PIN