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General NPI Number Information
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NPI Number | 1811360803
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Entity Type | Organization
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Legal Business Name | IHM SPORTS MEDICINE
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 5490 S MIAMI BLVD APT 207
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City | DURHAM
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State | NC
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Zip | 27703-8284
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Country | US
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Telephone | 855-590-9527
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1146
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City | MORRISVILLE
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State | NC
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Zip | 27560-1146
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Country | US
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Telephone | 855-590-9527
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Fax |
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Authorized Official
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Title or Position | CEO/SPORTS MEDICINE CONSULTANT
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Name | DR. LOWELL THOMAS FAISON
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Credential | DC
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Telephone | 855-590-9527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 4283
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License Number State | NC
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