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General NPI Number Information
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NPI Number | 1114707577
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Entity Type | Organization
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Legal Business Name | CAMEL CITY CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 10/03/2023
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 4622 COUNTRY CLUB RD STE 140
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3770
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Country | US
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Telephone | 336-768-7227
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Fax | 336-768-3802
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Provider Business Mailing Address
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Address Line | 4622 COUNTRY CLUB RD STE 140
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City | WINSTON SALEM
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State | NC
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Zip | 27104-3770
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Country | US
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Telephone | 336-768-7227
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Fax | 336-768-3802
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | DR. KEVIN M SHARP
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Credential | DC
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Telephone | 336-768-7227
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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 |
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License Number State |
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