Healthcare Provider Details

I. General information

NPI: 1811816929
Provider Name (Legal Business Name): ALYSSA MARIE GAINES DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 CHARLIE MEDLIN DR STE E
SURF CITY NC
28445-7921
US

IV. Provider business mailing address

108 CHARLIE MEDLIN DR STE E
SURF CITY NC
28445-7921
US

V. Phone/Fax

Practice location:
  • Phone: 910-702-4476
  • Fax:
Mailing address:
  • Phone: 910-702-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6062
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: