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General NPI Number Information
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NPI Number | 1285056630
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Entity Type | Organization
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Legal Business Name | CAROLINA SPORTS, SPINE & WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 01/19/2014
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Last Update Date | 01/19/2014
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Provider Practice Location Address
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Address Line | 3150 N ELM ST SUITE 103
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City | GREENSBORO
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State | NC
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Zip | 27408-3880
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Country | US
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Telephone | 336-763-3756
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Fax | 336-763-3757
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Provider Business Mailing Address
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Address Line | PO BOX 13647
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City | GREENSBORO
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State | NC
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Zip | 27415-3647
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Country | US
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Telephone | 336-763-3756
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Fax | 336-763-3757
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SCOTT DAVID WEAVER
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Credential | D.C.
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Telephone | 419-494-7169
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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 | 4274
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License Number State | NC
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