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General NPI Number Information
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NPI Number | 1336386903
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Entity Type | Organization
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Legal Business Name | SHALLOTTE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 4501 MAIN ST STE 2
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City | SHALLOTTE
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State | NC
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Zip | 28470-4585
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Country | US
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Telephone | 910-754-8090
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Fax | 910-754-8480
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Provider Business Mailing Address
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Address Line | 4501 MAIN ST STE 2
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City | SHALLOTTE
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State | NC
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Zip | 28470-4585
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Country | US
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Telephone | 910-754-8090
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Fax | 910-754-8480
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROL A MYNATT
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Credential | D.C.
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Telephone | 910-754-8090
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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 | 3839
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3693
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License Number State | NC
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