Healthcare Provider Details

I. General information

NPI: 1184795049
Provider Name (Legal Business Name): AMERICAN BACK CARE CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4728 PARK RD STE B
CHARLOTTE NC
28209-3376
US

IV. Provider business mailing address

4728 PARK RD STE B
CHARLOTTE NC
28209-3376
US

V. Phone/Fax

Practice location:
  • Phone: 704-527-1020
  • Fax: 704-527-1060
Mailing address:
  • Phone: 704-527-1020
  • Fax: 704-527-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number3413
License Number StateNC

VIII. Authorized Official

Name: DR. BLAKE PRELIPP
Title or Position: PRESIDENT
Credential: D.C.
Phone: 704-527-1020