Healthcare Provider Details

I. General information

NPI: 1316102130
Provider Name (Legal Business Name): CAROLINA'S SPINE AND SPORTS TREATMENT CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
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

100 N TRYON ST STE B220-PMB 146
CHARLOTTE NC
28202-4000
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: DR. MATTHEW JAMES HARGREAVES
Title or Position: OWNER/DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 617-699-8541