MEDICARE: FUNCTION AND PERFORMANCE CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	4146	NC

General Provider Information

NPI Number	:	1003108994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTION AND PERFORMANCE CHIROPRACTIC

Provider Business Mailing Address
First Line	:	601 S KINGS DR STE F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3089
Country	:	US
Telephone Number	:	704-370-7775
Fax Number	:	704-370-7776

Provider Business Practice Location Address
First Line	:	601 S KINGS DR STE F
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3089
Country	:	US
Telephone Number	:	704-370-7775
Fax Number	:	704-370-7776

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RYAN MCGRANN
Credential	:	D.C.
Telephone Number	:	315-783-8877

Provider Enumeration Date	:	05/10/2011
Last Update Date	:	05/10/2011

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