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General NPI Number Information
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NPI Number | 1780753335
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Entity Type | Organization
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Legal Business Name | LAKE NORMAN PAIN RELIEF & WELLNESS
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 19315 W CATAWBA AVE SUITE 100
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City | CORNELIUS
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State | NC
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Zip | 28031-8650
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Country | US
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Telephone | 704-896-1811
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Fax | 704-896-1812
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Provider Business Mailing Address
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Address Line | 19315 W CATAWBA AVE SUITE 100
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City | CORNELIUS
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State | NC
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Zip | 28031-8650
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Country | US
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Telephone | 704-896-1811
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Fax | 704-896-1812
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. JOHN J CIPRIANI
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Credential | D.C.
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Telephone | 704-896-1811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 3473
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License Number State | NC
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