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General NPI Number Information
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NPI Number | 1003397993
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Entity Type | Organization
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Legal Business Name | DOC'S SPINE AND SPORTS MEDICINE
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 2045 RENAISSANCE PARK PL
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City | CARY
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State | NC
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Zip | 27513-2263
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Country | US
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Telephone | 919-545-4394
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Fax |
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Provider Business Mailing Address
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Address Line | 2723 JORDAN POINTE BLVD
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City | NEW HILL
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State | NC
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Zip | 27562-9306
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Country | US
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Telephone | 919-545-4394
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TODD ALAN DENT
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Credential | DC
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Telephone | 919-545-4394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 4831
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License Number State | NC
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