Healthcare Provider Details

I. General information

NPI: 1548540164
Provider Name (Legal Business Name): ERIC A GINTER DC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 SE CARY PKWY SUITE 100
CARY NC
27518-7419
US

IV. Provider business mailing address

930 SE CARY PKWY SUITE 100
CARY NC
27518-7419
US

V. Phone/Fax

Practice location:
  • Phone: 919-851-1515
  • Fax: 919-851-1518
Mailing address:
  • Phone: 919-851-1515
  • Fax: 919-851-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC A GINTER
Title or Position: PART OWNER
Credential: DC
Phone: 919-851-1515