MEDICARE: PURE CHIROPRACTIC

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	4573	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720455959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3105 ROCK HILL CHURCH RD
Second Line	:	SUITE 101
City	:	CONCORD
State	:	NC
Zip	:	28027-6703
Country	:	US
Telephone Number	:	704-793-1329
Fax Number	:	704-793-1392

Provider Business Practice Location Address
First Line	:	3105 ROCK HILL CHURCH RD
Second Line	:	SUITE 101
City	:	CONCORD
State	:	NC
Zip	:	28027-6703
Country	:	US
Telephone Number	:	704-793-1329
Fax Number	:	704-793-1392

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. JERRY JOHN POKORNEY
Credential	:	D.C.
Telephone Number	:	404-421-2562

Provider Enumeration Date	:	08/24/2015
Last Update Date	:	01/04/2016

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Directions to “PURE CHIROPRACTIC ” Practice Location

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