Healthcare Provider Details

I. General information

NPI: 1366382103
Provider Name (Legal Business Name): MATTHEW ANTHONY CULICERTO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W DIXON BLVD
SHELBY NC
28152-6546
US

IV. Provider business mailing address

15810 NORMANS LANDING DR
CHARLOTTE NC
28273-7154
US

V. Phone/Fax

Practice location:
  • Phone: 704-482-0135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6019
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: