MEDICARE: CHARLOTTE CHIROPRACTIC CENTER PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3379	NC

General Provider Information

NPI Number	:	1194175596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE CHIROPRACTIC CENTER PLLC

Provider Business Mailing Address
First Line	:	1341 E MOREHEAD ST STE 101
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2936
Country	:	US
Telephone Number	:	704-940-7740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1341 E MOREHEAD ST STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2937
Country	:	US
Telephone Number	:	704-940-7740
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KYLE EDWARD WALTZ
Credential	:	DC
Telephone Number	:	704-940-7740

Provider Enumeration Date	:	06/16/2016
Last Update Date	:	06/16/2016

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