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General NPI Number Information
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NPI Number | 1720486400
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Entity Type | Organization
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Legal Business Name | MY CHIRO, PLLC
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 115 INDIAN TRAIL RD N
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-7808
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Country | US
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Telephone | 704-635-0262
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Fax |
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Provider Business Mailing Address
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Address Line | 124 UNIONVILLE INDIAN TRAIL RD W SUITE B4
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5591
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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 | MEMBER & MANAGER
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Name | DR. MAZYAR NESHAT
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Credential | D.C.
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Telephone | 704-635-0262
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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 | 2976
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License Number State | NC
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