Healthcare Provider Details

I. General information

NPI: 1073303962
Provider Name (Legal Business Name): MIDTOWN CHIROPRACTIC CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 PACIFIC DR
RALEIGH NC
27609-8106
US

IV. Provider business mailing address

1705 PACIFIC DR
RALEIGH NC
27609-8106
US

V. Phone/Fax

Practice location:
  • Phone: 919-873-2225
  • Fax:
Mailing address:
  • Phone: 919-873-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: BRIAN SPENCER EATON
Title or Position: MEMBER/CHIROPRACTOR
Credential: DC
Phone: 702-677-7140