Old Bridge Chiropractic, PLLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

4572 Issued in NC

Legal business name

OLD BRIDGE CHIROPRACTIC, PLLC

Practice address

4022 Old Bridge Rd SE Ste D
Southport, NC 28461-9286

Phone

(910) 363-4139

NPI assigned

Aug 21, 2015

Organization subpart

No

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

Authorized official

Name

Seth Myer Deletetsky, DCNPI 1114246527

Title

Chiropractor

Phone

(207) 590-9756

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 2

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

• Seth M Deletetsky, DC

  • Chiropractor
  • Southport, NC
  • NPI 1114246527
  Medicare reassignment NPD Authorized official
• Hilary Joyce Rutledge, DC

  • Chiropractor
  • San Diego, CA
  • NPI 1730229873
  NPD (past)

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1326415670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4022 OLD BRIDGE RD SE STE D",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619286",
            "telephone_number": "910-363-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4022 OLD BRIDGE RD SE STE D",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619286",
            "telephone_number": "910-363-4139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD BRIDGE CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "DELETETSKY",
        "authorized_official_first_name": "SETH",
        "authorized_official_middle_name": "MYER",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "207-590-9756",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "4572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Southport, NC
• Providers in Southport, NC by specialty
• Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2015; 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.