Healthcare Provider Details

I. General information

NPI: 1619019858
Provider Name (Legal Business Name): FIDELITY CHIROPRACTIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 RAINBOW DR
KANNAPOLIS NC
28081-4746
US

IV. Provider business mailing address

242 OAK AVE STE 155
KANNAPOLIS NC
28081-4329
US

V. Phone/Fax

Practice location:
  • Phone: 704-652-1393
  • Fax:
Mailing address:
  • Phone: 980-330-1680
  • Fax: 704-782-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNC

VIII. Authorized Official

Name: RANDY JOE WILLIS
Title or Position: MANAGER
Credential: D.C.
Phone: 704-652-1393