NPIMap

Organization Active NPI

Healthsource of Lake Boone Trail, PLLC

  • Chiropractor
  • Raleigh, NC
National Provider Identifier
1255616611
Registry record updated Nov 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3364 Issued in NC
Legal business name
HEALTHSOURCE OF LAKE BOONE TRAIL, PLLC
Practice address
4025 Lake Boone TRL
Suite 120
Raleigh, NC 27607-2986
Phone
(919) 785-9191
Fax
(919) 785-9193
NPI assigned
Oct 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2011

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

Authorized official

Name
Mrs. Lisa C Evans
Title
Billing Manager
Phone
(919) 585-7365

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3364 NC Primary

Addresses

Primary practice location

4025 Lake Boone TRL
Suite 120
Raleigh, NC 27607-2986

Mailing address

4025 Lake Boone Trail
Suite 120
Raleigh, NC 27607-2986
Phone (910) 431-4330

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1318896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320883200000",
    "number": "1255616611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4025 LAKE BOONE TRAIL",
            "address_2": "SUITE 120",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276072986",
            "telephone_number": "910-431-4330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4025 LAKE BOONE TRL",
            "address_2": "SUITE 120",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276072986",
            "telephone_number": "919-785-9191",
            "fax_number": "919-785-9193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE OF LAKE BOONE TRAIL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-18",
        "last_updated": "2011-11-10",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "919-585-7365",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3364",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.