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General NPI Number Information
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NPI Number | 1386826618
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Entity Type | Organization
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Legal Business Name | FOUNDATION CHIROPRACTIC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 11/28/2007
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Provider Practice Location Address
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Address Line | 2886 SOUTH LOOKOUT STREET
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City | CLAREMONT
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State | NC
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Zip | 28610
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Country | US
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Telephone | 828-459-1050
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 86
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City | CLAREMONT
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State | NC
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Zip | 28610
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE LANG WITHERS
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Credential | D.C.
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Telephone | 828-459-1050
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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 | 3305
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License Number State | NC
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