Healthcare Provider Details

I. General information

NPI: 1407286990
Provider Name (Legal Business Name): CAROLINA SPORTS CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ESTES DR
CHAPEL HILL NC
27514-7001
US

IV. Provider business mailing address

201 S ESTES DR
CHAPEL HILL NC
27514-7001
US

V. Phone/Fax

Practice location:
  • Phone: 919-903-8727
  • Fax: 919-903-8667
Mailing address:
  • Phone: 919-903-8727
  • Fax: 919-903-8667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA L KOLLMANN
Title or Position: OWNER
Credential: DC
Phone: 919-903-8727