=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831984400
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPINE & SPORTS CHIROPRACTIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2025
-----------------------------------------------------
Last Update Date | 04/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 SUTTLES RD STE 150
-----------------------------------------------------
City | PITTSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27312-5531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-980-1388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 93 CIRCLE CITY WAY
-----------------------------------------------------
City | PITTSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27312-1808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-980-1388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT ALEXANDER KALLIO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 402-980-1388
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------