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NPI Code Detail

MEDICARE: DR. VINCENT MARK CARDELL D.C.

MEDICARE: DR. VINCENT MARK CARDELL D.C.
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
1111N00000XChiropractor1473NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
108362OTHERNCBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1124146352
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VINCENT MARK CARDELL D.C.
Provider Business Mailing Address
First Line : 809 N LAFAYETTE ST
Second Line :
City : SHELBY
State : NC
Zip : 28150-3978
Country : US
Telephone Number : 704-482-2225
Fax Number : 704-482-2077
Provider Business Practice Location Address
First Line : 809 N LAFAYETTE ST
Second Line :
City : SHELBY
State : NC
Zip : 28150-3978
Country : US
Telephone Number : 704-482-2225
Fax Number : 704-482-2077
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2007
Last Update Date : 07/08/2007

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