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General NPI Number Information
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NPI Number | 1245730605
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Entity Type | Individual
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Provider Name | SCOTT CARLTON COUNCILMAN II
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Gender | Male
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Dates
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Enumeration Date | 02/12/2018
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 8511 COLONNADE CENTER DR STE 132
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City | RALEIGH
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State | NC
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Zip | 27615-3067
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Country | US
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Telephone | 919-848-7774
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Fax |
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Provider Business Mailing Address
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Address Line | 218C S FRONT ST
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City | NEW BERN
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State | NC
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Zip | 28560-2136
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Country | US
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Telephone | 919-356-5680
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4900
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License Number State | NC
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