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General NPI Number Information
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NPI Number | 1972858405
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Entity Type | Organization
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Legal Business Name | EXODUS CHIROPRACTIC CHARLOTTE PLLC
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 15940 NORTHCROSS DR STE B
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5062
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Country | US
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Telephone | 704-584-9299
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Fax |
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Provider Business Mailing Address
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Address Line | 1595 COLD CREEK PL
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-3646
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Country | US
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Telephone | 810-841-3933
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Fax |
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Authorized Official
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Title or Position | MEMBER/ORGANIZER
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Name | DR. BRANDON BRIAN MAHAFFY
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Credential | D.C.
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Telephone | 704-584-9299
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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 | 4287
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License Number State | NC
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