Healthcare Provider Details

I. General information

NPI: 1780753335
Provider Name (Legal Business Name): LAKE NORMAN PAIN RELIEF & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19315 W CATAWBA AVE SUITE 100
CORNELIUS NC
28031-8650
US

IV. Provider business mailing address

19315 W CATAWBA AVE SUITE 100
CORNELIUS NC
28031-8650
US

V. Phone/Fax

Practice location:
  • Phone: 704-896-1811
  • Fax: 704-896-1812
Mailing address:
  • Phone: 704-896-1811
  • Fax: 704-896-1812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3473
License Number StateNC

VIII. Authorized Official

Name: DR. JOHN J CIPRIANI
Title or Position: CHIROPRACTIC PHYSICIAN
Credential: D.C.
Phone: 704-896-1811