Healthcare Provider Details

I. General information

NPI: 1043754344
Provider Name (Legal Business Name): 1ST CHOICE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2016
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 CIRCLEWOOD DR
HAMLET NC
28345-4526
US

IV. Provider business mailing address

936 CIRCLEWOOD DR
HAMLET NC
28345-4526
US

V. Phone/Fax

Practice location:
  • Phone: 910-895-6042
  • Fax: 910-895-3199
Mailing address:
  • Phone: 910-895-6042
  • Fax: 910-895-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4099
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1885
License Number StateNC

VIII. Authorized Official

Name: LARRY EUGENE STOGNER
Title or Position: OWNER/PRESIDENT
Credential: DC
Phone: 910-895-6042