Provider Demographics
NPI:1871793802
Name:ATLANTIC CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:ATLANTIC CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-395-2774
Mailing Address - Street 1:3715 PATRIOT WAY
Mailing Address - Street 2:UNIT 143
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6907
Mailing Address - Country:US
Mailing Address - Phone:910-395-2774
Mailing Address - Fax:910-395-2474
Practice Address - Street 1:3715 PATRIOT WAY
Practice Address - Street 2:UNIT 143
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-6907
Practice Address - Country:US
Practice Address - Phone:910-395-2774
Practice Address - Fax:910-395-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02301OtherBC/BS #
NC2455457Medicare PIN