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General NPI Number Information
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NPI Number | 1255043766
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Entity Type | Organization
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Legal Business Name | 910 CHIROPRACTIC PC
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Dates
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Enumeration Date | 12/15/2022
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Last Update Date | 12/27/2022
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Provider Practice Location Address
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Address Line | 108 CHARLIE MEDLIN DR STE E
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City | SURF CITY
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State | NC
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Zip | 28445-7921
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Country | US
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Telephone | 910-702-4476
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Fax |
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Provider Business Mailing Address
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Address Line | 108 CHARLIE MEDLIN DR STE E
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City | SURF CITY
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State | NC
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Zip | 28445-7921
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Country | US
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Telephone | 910-702-4476
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JONATHAN T AMDUR
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Credential | DC
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Telephone | 910-702-4476
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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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