MEDICARE: RED CLAY CHIROPRACTIC, PC

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	111NN0400X	Neurology Chiropractor

General Provider Information

NPI Number	:	1205616125
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED CLAY CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	1895 N NC 16 BUSINESS HWY
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8642
Country	:	US
Telephone Number	:	704-489-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1895 N NC 16 BUSINESS HWY
Second Line	:
City	:	DENVER
State	:	NC
Zip	:	28037-8642
Country	:	US
Telephone Number	:	704-489-2273
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JASON LANGHOUGH
Credential	:	DC
Telephone Number	:	704-608-3744

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	11/22/2023

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