Healthcare Provider Details

I. General information

NPI: 1801832811
Provider Name (Legal Business Name): LAKE NORMAN CHIROPRACTIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N MAIN ST
MOORESVILLE NC
28115-2312
US

IV. Provider business mailing address

612 N MAIN ST
MOORESVILLE NC
28115-2312
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-3455
  • Fax: 704-664-2827
Mailing address:
  • Phone: 704-664-3455
  • Fax: 704-664-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD FULTON ABERNATHY
Title or Position: PRESIDENT
Credential: D.C., C.C.S.P.
Phone: 704-664-3455