MEDICARE: CAROLINA CHIROPRACTIC GROUP UNIVERSITY PLLC

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

General Provider Information

NPI Number	:	1104780394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CHIROPRACTIC GROUP UNIVERSITY PLLC

Provider Business Mailing Address
First Line	:	8821 UNIVERSITY EAST DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4200
Country	:	US
Telephone Number	:	704-428-9006
Fax Number	:	704-710-8037

Provider Business Practice Location Address
First Line	:	8821 UNIVERSITY EAST DR STE 120
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-4364
Country	:	US
Telephone Number	:	704-428-9006
Fax Number	:	704-710-8037

Authorized Official
Title or Position	:	OWNER/DOCTOR
Name	:	BRADLEY MOFFITT
Credential	:	DC
Telephone Number	:	704-428-9006

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	02/02/2026

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