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General NPI Number Information
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NPI Number | 1285000646
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Entity Type | Organization
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Legal Business Name | HOLLY RIDGE CHIROPRACTIC & AUTO INJURY
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 119 HOLLY ST
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City | HOLLY RIDGE
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State | NC
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Zip | 28445
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Country | US
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Telephone | 910-329-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 GUM BRANCH RD
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City | JACKSONVILLE
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State | NC
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Zip | 28540-5016
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Country | US
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Telephone | 919-455-6696
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID JOHN TAYLOR
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Credential |
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Telephone | 910-329-4455
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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 | 2621
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License Number State | NC
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