Provider Demographics
NPI:1861433054
Name:BELMONT CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:BELMONT CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVANDA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:DEMPERIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-825-9799
Mailing Address - Street 1:5803 W WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-4809
Mailing Address - Country:US
Mailing Address - Phone:704-825-9799
Mailing Address - Fax:704-825-9977
Practice Address - Street 1:5803 W WILKINSON BLVD
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-4809
Practice Address - Country:US
Practice Address - Phone:704-825-9799
Practice Address - Fax:704-825-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1388111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908680Medicaid