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General NPI Number Information
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NPI Number | 1679715650
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Entity Type | Organization
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Legal Business Name | INDIAN TRAIL CHIROPRACTIC & REHABILITATION, PA
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Dates
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Enumeration Date | 04/06/2009
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Last Update Date | 04/06/2009
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Provider Practice Location Address
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Address Line | 100 PARK ROAD EAST
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City | INDIAN TRAIL
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State | NC
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Zip | 28079
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Country | US
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Telephone | 704-821-3222
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Fax | 704-821-3290
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Provider Business Mailing Address
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Address Line | PO BOX 812
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-0812
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Country | US
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Telephone | 704-821-3222
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Fax | 704-821-3290
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW M EVEC
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Credential | DC
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Telephone | 704-821-3222
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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 | 2732
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License Number State | NC
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