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General NPI Number Information
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NPI Number | 1285681833
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Entity Type | Organization
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Legal Business Name | BRONSON CHIROPRACTIC & ACUPUNCTURE CLINIC OF THE TRIAD, PLLC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 200 CHARLOIS BLVD SUITE 100
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1536
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Country | US
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Telephone | 336-765-0404
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Fax | 336-765-0304
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Provider Business Mailing Address
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Address Line | 200 CHARLOIS BLVD SUITE 100
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1536
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Country | US
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Telephone | 336-765-0404
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Fax | 336-765-0304
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | AMY ALICE BRONSON
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Credential | D.C.
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Telephone | 336-765-0404
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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 | 2260
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License Number State | NC
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