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General NPI Number Information
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NPI Number | 1831149285
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Entity Type | Organization
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Legal Business Name | CHERRY POINT CHIROPRACTIC & REHABILITATION CENTER PA
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 05/02/2016
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Provider Practice Location Address
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Address Line | 318 E MAIN ST
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City | HAVELOCK
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State | NC
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Zip | 28532-2214
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Country | US
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Telephone | 252-444-3377
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Fax | 252-444-3529
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Provider Business Mailing Address
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Address Line | 318 E MAIN ST
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City | HAVELOCK
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State | NC
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Zip | 28532-2214
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Country | US
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Telephone | 252-444-3377
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Fax | 252-444-3529
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | DR. RUSSELL KELSO DAVIS
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Credential | DC ATC
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Telephone | 252-444-3377
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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 | 2801
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License Number State | NC
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