Healthcare Provider Details

I. General information

NPI: 1053428912
Provider Name (Legal Business Name): SHERWOOD FOREST HINSON JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E 3RD ST
PEMBROKE NC
28372-8889
US

IV. Provider business mailing address

PO BOX 3028
PEMBROKE NC
28372-3028
US

V. Phone/Fax

Practice location:
  • Phone: 910-521-7800
  • Fax: 910-521-7893
Mailing address:
  • Phone: 910-521-7800
  • Fax: 910-521-7893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1427
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: