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General NPI Number Information
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NPI Number | 1356961007
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Entity Type | Organization
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Legal Business Name | LAKE NORMAN INTEGRATIVE WELLNESS, LLC
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 21000 TORRENCE CHAPEL RD STE 101
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City | CORNELIUS
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State | NC
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Zip | 28031-6874
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Country | US
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Telephone | 704-987-3993
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Fax | 704-987-3991
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Provider Business Mailing Address
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Address Line | 21000 TORRENCE CHAPEL RD STE 101
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City | CORNELIUS
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State | NC
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Zip | 28031-6874
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Country | US
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Telephone | 704-987-3993
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Fax | 704-987-3991
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. AKIBA JOSEPH GREEN
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Credential | DC, DNM
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Telephone | 704-658-7350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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