NPIMap

Organization Active NPI

Crabtree Chiropractic Center, PA

  • Chiropractor
  • Raleigh, NC
National Provider Identifier
1114946332
Registry record updated Jul 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
CRABTREE CHIROPRACTIC CENTER, PA
Practice address
4517 Lead Mine Rd
Raleigh, NC 27612-3326
Phone
(919) 781-8830
Fax
(919) 781-1678
NPI assigned
Jul 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles B Kubasko, DCNPI 1225056096
Title
Owner
Phone
(919) 781-8830

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X NC
ChiropractorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

4517 Lead Mine Rd
Raleigh, NC 27612-3326

Mailing address

4517 Lead Mine Rd
Raleigh, NC 27612-3326
Phone (919) 781-8830

Other identifiers 2

IdentifierTypeStateIssuer
0821FOtherNCBLUE CROSS BLUE SHIELD
890821FMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090916000026 NC Part B Supplier - Clinic/Group Practice 9931151644 Receives reassigned benefits from 3 practitioners
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

4517 Lead Mine Rd
Raleigh, NC 27612
Phone (919) 781-8830

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247184000000",
    "number": "1114946332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 LEAD MINE RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123326",
            "telephone_number": "919-781-8830",
            "fax_number": "919-781-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 LEAD MINE RD",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276123326",
            "telephone_number": "919-781-8830",
            "fax_number": "919-781-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRABTREE CHIROPRACTIC CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2009-07-10",
        "status": "A",
        "authorized_official_last_name": "KUBASKO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-781-8830",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0821F",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "890821F",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.