Provider Demographics
NPI:1871787929
Name:WILMINGTON UPPER CERVICAL CENTER, CORP
Entity type:Organization
Organization Name:WILMINGTON UPPER CERVICAL CENTER, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ENGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-799-5935
Mailing Address - Street 1:1302 S 39TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6700
Mailing Address - Country:US
Mailing Address - Phone:910-799-5935
Mailing Address - Fax:910-799-5936
Practice Address - Street 1:1302 S 39TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6700
Practice Address - Country:US
Practice Address - Phone:910-799-5935
Practice Address - Fax:910-799-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3714111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0855YOtherBCBS