MEDICARE: CENTERED CHIROPRACTIC PA

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

General Provider Information

NPI Number	:	1477120806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERED CHIROPRACTIC PA

Provider Business Mailing Address
First Line	:	8928 US 70 BUS HWY W STE 700
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-4847
Country	:	US
Telephone Number	:	919-553-5505
Fax Number	:	919-553-9909

Provider Business Practice Location Address
First Line	:	8928 US 70 BUS HWY W STE 700
Second Line	:
City	:	CLAYTON
State	:	NC
Zip	:	27520-4847
Country	:	US
Telephone Number	:	919-553-5505
Fax Number	:	919-553-9909

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JORDAN BONHAM
Credential	:	DC
Telephone Number	:	412-251-8573

Provider Enumeration Date	:	06/04/2021
Last Update Date	:	08/10/2021

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Directions to “CENTERED CHIROPRACTIC PA ” Practice Location

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