NPIMap

Organization Active NPI

Blue Ridge Health and Spine, PLLC

Doing business as Family First Health Center

  • Chiropractor
  • Shallotte, NC
National Provider Identifier
1497204101
Registry record updated Sep 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4536 Issued in NC
Legal business name
BLUE RIDGE HEALTH AND SPINE, PLLC
Doing business as
Family First Health Center
Practice address
4911 Bridgers Road
Shallotte, NC 28470-4474
Phone
(910) 755-5483
Fax
(910) 755-5484
NPI assigned
Sep 23, 2016
Last updated
Sep 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2016

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

Authorized official

Name
Monique Jessica Weddle, DCNPI 1184022899
Title
Owner
Phone
(910) 755-5483

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
Chiropractor 111N00000X 4536 NC Primary

Addresses

Primary practice location

4911 Bridgers Road
Shallotte, NC 28470-4474

Mailing address

PO Box 1945
Shallotte, NC 28459-1945
Phone (910) 755-5483

Other identifiers 1

IdentifierTypeStateIssuer
1184022899MedicaidNC

Other names 1

  • Family First Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161122000434 NC Part B Supplier - Clinic/Group Practice 8921387531 Receives reassigned benefits from 3 practitioners
Practice locations: Shallotte, NC

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1474588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1497204101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1945",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284591945",
            "telephone_number": "910-755-5483",
            "fax_number": "910-755-5484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4911 BRIDGERS ROAD",
            "city": "SHALLOTTE",
            "state": "NC",
            "postal_code": "284704474",
            "telephone_number": "910-755-5483",
            "fax_number": "910-755-5484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE HEALTH AND SPINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-23",
        "last_updated": "2016-09-23",
        "status": "A",
        "authorized_official_last_name": "WEDDLE",
        "authorized_official_first_name": "MONIQUE",
        "authorized_official_middle_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "910-755-5483",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "4536",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184022899",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family First Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shallotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; 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.