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General NPI Number Information
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NPI Number | 1538452982
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Entity Type | Organization
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Legal Business Name | DYNAMIC HEALTH AND PAIN MANAGEMENT, PLLC
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/09/2017
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Provider Practice Location Address
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Address Line | 4707 SOUTH BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28217-2117
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Country | US
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Telephone | 704-525-6288
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Fax | 704-525-6384
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Provider Business Mailing Address
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Address Line | 4707 SOUTH BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28217-2117
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Country | US
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Telephone | 704-525-6288
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Fax | 704-525-6384
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | HEIDI COX
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Credential |
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Telephone | 704-525-6288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 222692
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 9900407
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License Number State | NC
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