Healthcare Provider Details

I. General information

NPI: 1316441785
Provider Name (Legal Business Name): SUTPHIN CHIROPRACTIC ACUPUNCTURE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SALEM TOWNE CT
APEX NC
27502-2311
US

IV. Provider business mailing address

7808 GLENHARDEN DR
RALEIGH NC
27613-1521
US

V. Phone/Fax

Practice location:
  • Phone: 919-909-1095
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number4814
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. REBECCA SUTPHIN
Title or Position: CHIROPRACTOR
Credential: DC, MA
Phone: 919-909-1095