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General NPI Number Information
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NPI Number | 1841956661
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL CHIROPRACTIC & REHAB, PLLC
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Dates
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Enumeration Date | 11/16/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 4446 STILL PINES DR
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City | RALEIGH
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State | NC
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Zip | 27613-3333
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Country | US
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Telephone | 315-857-5197
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 SPRING FOREST RD STE 100
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City | RALEIGH
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State | NC
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Zip | 27615-5844
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JOSEPH GUARDINO
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Credential | D.C.
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Telephone | 919-473-9072
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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 |
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License Number State |
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