MEDICARE: CAROLINA SPINE & REHAB CENTER

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	3178	NC

General Provider Information

NPI Number	:	1821114117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA SPINE & REHAB CENTER

Provider Business Mailing Address
First Line	:	5110 PARK RD STE 2A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3745
Country	:	US
Telephone Number	:	704-525-8850
Fax Number	:	704-525-8860

Provider Business Practice Location Address
First Line	:	5110 PARK RD STE 2A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3745
Country	:	US
Telephone Number	:	704-525-8850
Fax Number	:	704-525-8860

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JANE S CIUCEVICH
Credential	:
Telephone Number	:	704-624-0527

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	08/22/2020

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