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General NPI Number Information
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NPI Number | 1538428347
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Entity Type | Organization
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Legal Business Name | CAROLINA SPINAL CARE & LASER THERAPY CENTER PC
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Dates
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Enumeration Date | 05/14/2012
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Last Update Date | 05/14/2012
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Provider Practice Location Address
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Address Line | 12201 N NC HIGHWAY 150 SUITE #4
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City | WINSTON SALEM
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State | NC
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Zip | 27127-9731
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Country | US
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Telephone | 336-775-7600
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Fax | 336-775-7610
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Provider Business Mailing Address
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Address Line | 12201 N NC HIGHWAY 150 SUITE #4
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City | WINSTON SALEM
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State | NC
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Zip | 27127-9731
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Country | US
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Telephone | 336-775-7600
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Fax | 336-775-7610
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Authorized Official
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Title or Position | DOCTOR/CEO
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Name | DR. DAMIAN SEAN SCELFO
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Credential | DC
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Telephone | 336-775-7600
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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 | 3038
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License Number State | NC
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