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General NPI Number Information
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NPI Number | 1427581479
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Entity Type | Organization
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Legal Business Name | NORTH STATE SPORT & SPINE
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 04/06/2017
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Provider Practice Location Address
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Address Line | 154 VILLAGE WALK DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540
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Country | US
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Telephone | 919-986-1492
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Fax |
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Provider Business Mailing Address
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Address Line | 154 VILLAGE WALK DR
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540
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Country | US
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Telephone | 919-986-1492
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EVAN KAHN
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Credential | DC
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Telephone | 919-986-1492
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 4054
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License Number State | NC
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