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General NPI Number Information
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NPI Number | 1790009504
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Entity Type | Organization
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Legal Business Name | MCMASTERS CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 1037 HOMELAND AVE UNIT B
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City | GREENSBORO
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State | NC
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Zip | 27405-7003
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Country | US
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Telephone | 336-617-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 1037 HOMELAND AVE UNIT B
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City | GREENSBORO
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State | NC
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Zip | 27405-7003
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Country | US
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Telephone | 336-617-4783
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. KIM LAVETTE MCMASTERS
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Credential | DC
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Telephone | 336-617-4783
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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 | 4031
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License Number State | NC
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