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General NPI Number Information
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NPI Number | 1699720219
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Entity Type | Organization
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Legal Business Name | SHARP CHIROPRACTIC, PC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 4622 COUNTRY CLUB RD. STE. 140
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City | WINSTON SALEM
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State | NC
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Zip | 27104-4616
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Country | US
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Telephone | 336-768-7227
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Fax | 336-768-3802
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Provider Business Mailing Address
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Address Line | 4622 COUNTRY CLUB RD. 140
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City | WINSTON SALEM
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State | NC
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Zip | 27104-4616
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Country | US
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Telephone | 336-768-7227
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Fax | 336-768-3802
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Authorized Official
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Title or Position | PRESIDENT
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Name | KEVIN MARK SHARP
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Credential | DC
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Telephone | 336-768-7227
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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 | 19279
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License Number State | NC
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