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General NPI Number Information
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NPI Number | 1407028756
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Entity Type | Organization
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Legal Business Name | RALEIGH SPINE CENTER, PLLC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 03/27/2008
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Provider Practice Location Address
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Address Line | 1425 ROCK QUARRY RD SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27610-4100
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Country | US
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Telephone | 919-620-7900
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Fax | 919-479-5061
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Provider Business Mailing Address
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Address Line | 400 CRUTCHFIELD ST SUITE D
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City | DURHAM
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State | NC
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Zip | 27704-2771
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Country | US
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Telephone | 919-620-7900
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Fax | 919-479-5061
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS W LEGROW
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Credential | D.C.
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Telephone | 919-620-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 1958
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License Number State | NC
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