Healthcare Provider Details

I. General information

NPI: 1568083152
Provider Name (Legal Business Name): JUSTIN ANDREW OTT D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 SLATER RD STE 203
MORRISVILLE NC
27560-4532
US

IV. Provider business mailing address

2836 RAWLE ST
PHILADELPHIA PA
19149-2521
US

V. Phone/Fax

Practice location:
  • Phone: 919-757-4410
  • Fax:
Mailing address:
  • Phone: 215-380-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6066
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC012151
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: