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General NPI Number Information
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NPI Number | 1902156474
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Entity Type | Organization
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Legal Business Name | KINETIC SPINE & SPORTS
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 1928 WEDDINGTON RD
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City | WEDDINGTON
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State | NC
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Zip | 28104-8318
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Country | US
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Telephone | 704-849-0344
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Fax | 704-849-0521
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Provider Business Mailing Address
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Address Line | 1928 WEDDINGTON RD
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City | WEDDINGTON
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State | NC
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Zip | 28104-8318
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Country | US
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Telephone | 704-849-0344
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Fax | 704-849-0521
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Authorized Official
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Title or Position | OWNER
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Name | DR. DANIEL EDWARD DANIELEY
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Credential | DC
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Telephone | 704-849-0344
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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 | 4183
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3711
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License Number State | NC
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