Organization Active NPI

Laurel Park Chiropractic Center LLC

  • Chiropractor
  • Hendersonville, NC
National Provider Identifier
1174628416
Registry record updated Nov 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2136 Issued in NC
Legal business name
LAUREL PARK CHIROPRACTIC CENTER LLC
Practice address
212 S Grove St
Suite D
Hendersonville, NC 28792-4006
Phone
(828) 696-9090
NPI assigned
Sep 13, 2006
Last updated
Nov 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2012

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

Authorized official

Name
Dr. Roger Wayne Freed, D.C.NPI 1801845649
Title
Owner
Phone
(828) 696-9090

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 2136 NC Primary

Addresses

Primary practice location

212 S Grove St
Suite D
Hendersonville, NC 28792-4006

Mailing address

212 S Grove St
Suite D
Hendersonville, NC 28792-4006
Phone (828) 696-9090

Other identifiers 1

IdentifierTypeStateIssuer
1139COtherNCBCBSNC PROVIDER ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080216000085 NC Part B Supplier - Clinic/Group Practice 0244313096 Receives reassigned benefits from 2 practitioners
Practice locations: Hendersonville, NC

National Provider Directory

National Provider Directory

Locations

600 5th Ave W
Ste B
Hendersonville, NC 28739
Phone (828) 696-9090

212 S Grove St
Ste D
Hendersonvlle, NC 28792
Phone (828) 381-3138

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353974400000",
    "number": "1174628416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S GROVE ST",
            "address_2": "SUITE D",
            "city": "HENDERSONVILLE",
            "state": "NC",
            "postal_code": "287924006",
            "telephone_number": "828-696-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 S GROVE ST",
            "address_2": "SUITE D",
            "city": "HENDERSONVILLE",
            "state": "NC",
            "postal_code": "287924006",
            "telephone_number": "828-696-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUREL PARK CHIROPRACTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2012-11-27",
        "status": "A",
        "authorized_official_last_name": "FREED",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "828-696-9090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "2136",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC PROVIDER ID",
            "identifier": "1139C",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2012; 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.