MEDICARE: SOUTH CHARLOTTE SPINE AND WELLNESS CENTER, 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	111N00000X	Chiropractor	3235	NC

General Provider Information

NPI Number	:	1285850248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CHARLOTTE SPINE AND WELLNESS CENTER, PC

Provider Business Mailing Address
First Line	:	342 CARL ELLER RD
Second Line	:
City	:	MARS HILL
State	:	NC
Zip	:	28754-6000
Country	:	US
Telephone Number	:	47-560-2369
Fax Number	:

Provider Business Practice Location Address
First Line	:	342 CARL ELLER RD
Second Line	:
City	:	MARS HILL
State	:	NC
Zip	:	28754-6000
Country	:	US
Telephone Number	:	47-560-2369
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JACQUELINE JESSICA LEONARD
Credential	:	DC
Telephone Number	:	47-560-2369

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	03/11/2019

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