Healthcare Provider Details

I. General information

NPI: 1245110527
Provider Name (Legal Business Name): BIOCURE OF THE CAROLINAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W BLUE RIDGE RD
FLAT ROCK NC
28731-1806
US

IV. Provider business mailing address

1150 W BLUE RIDGE RD
FLAT ROCK NC
28731-1806
US

V. Phone/Fax

Practice location:
  • Phone: 305-904-4211
  • Fax:
Mailing address:
  • Phone: 305-904-4211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MARSHALL KANNER
Title or Position: MANAGER
Credential: COO
Phone: 305-904-4211