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General NPI Number Information
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NPI Number | 1770917742
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Entity Type | Organization
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Legal Business Name | RACE CITY CHIROPRACTIC
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Dates
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Enumeration Date | 08/27/2013
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Last Update Date | 08/27/2013
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Provider Practice Location Address
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Address Line | 131 CROSSLAKE PARK DR #101
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City | MOORESVILLE
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State | NC
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Zip | 28117-8233
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Country | US
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Telephone | 404-863-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 131 CROSSLAKE PARK DR #101
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City | MOORESVILLE
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State | NC
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Zip | 28117-8233
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Country | US
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Telephone | 404-863-7100
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | GRANT H SIKES
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Credential | D.C.
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Telephone | 404-863-7100
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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 | 4635
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License Number State | NC
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