Provider Demographics
NPI:1447322086
Name:BLUE RIDGE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:BLUE RIDGE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SZOSTCZUK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-274-1122
Mailing Address - Street 1:1378 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1957
Mailing Address - Country:US
Mailing Address - Phone:828-274-1122
Mailing Address - Fax:828-274-3366
Practice Address - Street 1:1378 HENDERSONVILLE RD
Practice Address - Street 2:SUITE C
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1957
Practice Address - Country:US
Practice Address - Phone:828-274-1122
Practice Address - Fax:828-274-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2957111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085E0Medicaid
NC085E0OtherNCBCBS
NC2347776Medicare ID - Type Unspecified