Healthcare Provider Details

I. General information

NPI: 1730468919
Provider Name (Legal Business Name): GASTONIA SPINE & SPORT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 HOFFMAN RD STE 6
GASTONIA NC
28054-7524
US

IV. Provider business mailing address

PO BOX 550307
GASTONIA NC
28055-0307
US

V. Phone/Fax

Practice location:
  • Phone: 704-990-8266
  • Fax:
Mailing address:
  • Phone: 704-990-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number4142
License Number StateNC

VIII. Authorized Official

Name: DR. AARON JOSEPH STUMP
Title or Position: OWNER/PRESIDENT
Credential: D.C
Phone: 704-990-8266