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General NPI Number Information
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NPI Number | 1619397841
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC ADVANTAGE PA
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 04/28/2014
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Provider Practice Location Address
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Address Line | 1411 FORT BRAGG RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-4707
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Country | US
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Telephone | 910-486-9511
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 53703
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-3703
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Country | US
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Telephone |
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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. ROBERT W TWADDELL
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Credential | DC
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Telephone | 910-486-9511
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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 | 2347
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License Number State | NC
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