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General NPI Number Information
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NPI Number | 1013086909
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Entity Type | Organization
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Legal Business Name | GORLESKY BACK & NECK CHIROPRACTIC, INC
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 S WHITE ST
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City | WAKE FOREST
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State | NC
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Zip | 27587-2916
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Country | US
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Telephone | 919-556-1033
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Fax | 919-556-1034
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Provider Business Mailing Address
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Address Line | 301 S WHITE ST
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City | WAKE FOREST
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State | NC
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Zip | 27587-2916
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Country | US
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Telephone | 919-556-1033
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Fax | 919-556-1034
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACK GORLESKY
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Credential | DC
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Telephone | 919-556-1033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1030
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License Number State | NC
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