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General NPI Number Information
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NPI Number | 1194125005
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Entity Type | Organization
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Legal Business Name | LITTLE RIVER CLINIC OF CHIROPRACTIC INC
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 11/02/2015
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Provider Practice Location Address
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Address Line | 34 OLEANDER DR STE 104
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City | CLAYTON
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State | NC
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Zip | 27527-4599
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Country | US
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Telephone | 919-585-1313
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Fax | 919-585-1350
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Provider Business Mailing Address
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Address Line | 34 OLEANDER DR STE 104
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City | CLAYTON
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State | NC
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Zip | 27527-4599
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Country | US
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Telephone | 919-585-1313
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Fax | 919-585-1350
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. JESSICA GUNDELFINGER
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Credential | D.C.
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Telephone | 919-585-1313
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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 | 4506
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License Number State | NC
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