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General NPI Number Information
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NPI Number | 1235438722
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE NUMBER 2 LLC
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Dates
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Enumeration Date | 03/23/2011
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Last Update Date | 05/03/2012
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Provider Practice Location Address
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Address Line | 500 HOLLY SPRINGS RD SUITE 101
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-6204
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Country | US
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Telephone | 919-744-4010
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Fax | 919-829-5808
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Provider Business Mailing Address
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Address Line | 500 HOLLY SPRINGS RD SUITE 101
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-6204
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Country | US
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Telephone | 919-744-4010
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Fax | 919-829-5808
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | HOWARD GREEN
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Credential | DC
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Telephone | 919-744-4010
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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 | 3382
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License Number State | NC
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