Provider Demographics
NPI:1184703449
Name:EAGLE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:EAGLE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-596-5800
Mailing Address - Street 1:6116 N TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-7815
Mailing Address - Country:US
Mailing Address - Phone:704-596-5800
Mailing Address - Fax:704-509-6001
Practice Address - Street 1:6116 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7815
Practice Address - Country:US
Practice Address - Phone:704-596-5800
Practice Address - Fax:704-509-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1494111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08377OtherBCBS ID
NC18021OtherPARTNERS ID
NC8908377Medicaid
NC330149OtherACN
NCT64492Medicare UPIN
NC244466Medicare PIN