MEDICARE: SHARP CHIROPRACTIC, PC

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	19279	NC

General Provider Information

NPI Number	:	1699720219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARP CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	4622 COUNTRY CLUB RD.
Second Line	:	140
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-4616
Country	:	US
Telephone Number	:	336-768-7227
Fax Number	:	336-768-3802

Provider Business Practice Location Address
First Line	:	4622 COUNTRY CLUB RD.
Second Line	:	STE. 140
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-4616
Country	:	US
Telephone Number	:	336-768-7227
Fax Number	:	336-768-3802

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KEVIN MARK SHARP
Credential	:	DC
Telephone Number	:	336-768-7227

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	04/08/2008

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