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General NPI Number Information
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NPI Number | 1174834501
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Entity Type | Organization
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Legal Business Name | CAROLINA CHIROCARE AND REHAB INC.
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 09/11/2012
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Provider Practice Location Address
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Address Line | 1207 RIDGE RD
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City | RALEIGH
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State | NC
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Zip | 27607-6834
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Country | US
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Telephone | 919-809-7839
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Fax | 919-809-7839
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Provider Business Mailing Address
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Address Line | 1207 RIDGE RD
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City | RALEIGH
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State | NC
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Zip | 27607-6834
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Country | US
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Telephone | 919-809-7839
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Fax | 919-809-7839
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY S. GERDES
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Credential | D.C.
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Telephone | 919-809-7839
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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 | 3985
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License Number State | NC
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