Healthcare Provider Details

I. General information

NPI: 1144303108
Provider Name (Legal Business Name): MATTHEW JAMES HARGREAVES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N TRYON ST SUITE 1615
CHARLOTTE NC
28202-0200
US

IV. Provider business mailing address

718 W TRADE ST UNIT 409
CHARLOTTE NC
28202-1345
US

V. Phone/Fax

Practice location:
  • Phone: 617-699-8541
  • Fax:
Mailing address:
  • Phone: 617-699-8541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3450
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: