MEDICARE: STEELE CREEK CHIROPRACTIC, 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

General Provider Information

NPI Number	:	1639731581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEELE CREEK CHIROPRACTIC, PLLC

Provider Business Mailing Address
First Line	:	6220 CASTLECOVE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-6643
Country	:	US
Telephone Number	:	980-209-0932
Fax Number	:

Provider Business Practice Location Address
First Line	:	11709 FREUHAUF DR.
Second Line	:	SUITE 101
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-7285
Country	:	US
Telephone Number	:	980-209-0932
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROY NEIL VAN DYKE
Credential	:	D.C.
Telephone Number	:	980-209-0932

Provider Enumeration Date	:	07/01/2019
Last Update Date	:	07/01/2019

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