Healthcare Provider Details

I. General information

NPI: 1962043711
Provider Name (Legal Business Name): UNIVERSITY CITY CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8524 UNIVERSITY CITY BLVD
CHARLOTTE NC
28213-3579
US

IV. Provider business mailing address

104 BLACKBURN DR
GROVER NC
28073-9567
US

V. Phone/Fax

Practice location:
  • Phone: 704-568-6400
  • Fax:
Mailing address:
  • Phone: 704-300-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TYLER LEE MAXEY
Title or Position: OWNER
Credential: DC
Phone: 704-300-4268