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General NPI Number Information
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NPI Number | 1407194517
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Entity Type | Organization
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Legal Business Name | ACTIVE CHIROPRACTIC
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3410 SIX FORKS ROAD
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City | RALEIGH
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State | NC
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Zip | 27609-8521
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Country | US
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Telephone | 919-832-3365
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Fax | 919-832-8259
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Provider Business Mailing Address
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Address Line | 3410 SIX FORKS ROAD
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City | RALEIGH
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State | NC
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Zip | 27609-8521
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Country | US
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Telephone | 919-832-3365
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Fax | 919-832-8259
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | MOLLY B HALL
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Credential | DC
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Telephone | 919-832-3365
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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 | 3394
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License Number State | NC
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