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General NPI Number Information
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NPI Number | 1427667922
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Entity Type | Organization
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Legal Business Name | PROFOUND HEALTH PLLC
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 703 W SOUTH MAIN ST STE C
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City | WAXHAW
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State | NC
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Zip | 28173-6919
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Country | US
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Telephone | 704-453-3096
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 BLUE STREAM LN
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5769
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Country | US
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Telephone | 704-453-3096
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Fax |
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | NICHOLAS NIDAY
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Credential | DC
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Telephone | 704-453-3096
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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 |
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License Number State |
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