Healthcare Provider Details

I. General information

NPI: 1730268723
Provider Name (Legal Business Name): CHIROPRACTIC SPINE & SPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W MEADOWVIEW RD SUITE 121
GREENSBORO NC
27407-3720
US

IV. Provider business mailing address

2300 W MEADOWVIEW RD SUITE 121
GREENSBORO NC
27407-3720
US

V. Phone/Fax

Practice location:
  • Phone: 336-547-8811
  • Fax: 336-547-8811
Mailing address:
  • Phone: 336-547-8811
  • Fax: 336-547-8811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number3399
License Number StateNC

VIII. Authorized Official

Name: DR. MITCHELL EVANS
Title or Position: PRESIDENT
Credential: D.C.
Phone: 336-547-8811