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General NPI Number Information
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NPI Number | 1033278080
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Entity Type | Organization
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Legal Business Name | BAGWELL CHIROPRACTIC PA
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 10215 HICKORYWOOD HILL AVE STE A
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3429
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Country | US
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Telephone | 704-947-2902
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Fax | 704-947-2910
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Provider Business Mailing Address
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Address Line | 10215 HICKORYWOOD HILL AVE STE A
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3429
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Country | US
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Telephone | 704-947-2902
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Fax | 704-947-2910
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LONNIE ROBERT BAGWELL II
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Credential | DC
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Telephone | 704-947-2902
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3498
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License Number State | NC
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