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General NPI Number Information
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NPI Number | 1073922159
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC PHYSICIANS OF THE CAROLINAS
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Dates
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Enumeration Date | 08/04/2014
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Last Update Date | 01/16/2015
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Provider Practice Location Address
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Address Line | 513 S DEKALB ST
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City | SHELBY
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State | NC
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Zip | 28150-5926
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Country | US
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Telephone | 704-406-9939
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Fax | 704-406-9940
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Provider Business Mailing Address
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Address Line | 513 S DEKALB ST
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City | SHELBY
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State | NC
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Zip | 28150-5926
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Country | US
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Telephone | 704-406-9939
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Fax | 704-406-9940
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HEATHER BROOKE ELLISON
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Credential | D.C.
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Telephone | 704-406-9939
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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 | 4192
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License Number State | NC
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