Healthcare Provider Details

I. General information

NPI: 1427154566
Provider Name (Legal Business Name): SOUTHERN PINES CHIROPRACTIC, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 N BENNETT ST
SOUTHERN PINES NC
28387-4812
US

IV. Provider business mailing address

361 N BENNETT ST
SOUTHERN PINES NC
28387-4812
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-5207
  • Fax: 910-692-4487
Mailing address:
  • Phone: 910-692-5207
  • Fax: 910-692-4487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1784
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. CELIA COOK WAHL
Title or Position: VICE PRESIDENT
Credential: OFFICE MANAGER
Phone: 910-692-5207