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General NPI Number Information
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NPI Number | 1528343175
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Entity Type | Organization
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Legal Business Name | GONYEAU FAMILY CHIROPRACTIC
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 5281 SUNSET LAKE RD
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-3768
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Country | US
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Telephone | 919-267-4870
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Fax |
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Provider Business Mailing Address
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Address Line | 5281 SUNSET LAKE RD
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City | HOLLY SPRINGS
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State | NC
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Zip | 27540-3768
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Country | US
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Telephone | 919-267-4870
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | SHAWN THOMAS GONYEAU
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Credential | D.C.
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Telephone | 919-267-4870
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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 | 4134
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License Number State | NC
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