Healthcare Provider Details

I. General information

NPI: 1902305931
Provider Name (Legal Business Name): STUART CABELL WRIGHT DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 KING ST
KEYSVILLE VA
28277
US

IV. Provider business mailing address

7918 REA RD STE B
CHARLOTTE NC
28277-6575
US

V. Phone/Fax

Practice location:
  • Phone: 434-736-9895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4766
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: