Provider Demographics
NPI:1366993669
Name:YOUNGSVILLE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:YOUNGSVILLE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:BEAUMONT
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:919-556-2001
Mailing Address - Street 1:700 US 1 HWY
Mailing Address - Street 2:STE 400
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-7872
Mailing Address - Country:US
Mailing Address - Phone:919-556-2001
Mailing Address - Fax:919-556-2207
Practice Address - Street 1:700 US 1 HWY
Practice Address - Street 2:STE 400
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-7872
Practice Address - Country:US
Practice Address - Phone:919-556-2001
Practice Address - Fax:919-556-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3193111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437121878OtherNPI
NC1992873236Medicare UPIN
NC2456906Medicare PIN