MEDICARE: FIRST CHOICE CHIROPRACTIC AND WELLNESS CENTER

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	016GW	OTHER	NC	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1366465585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE CHIROPRACTIC AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	3535 RANDOLPH RD
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1032
Country	:	US
Telephone Number	:	704-379-7990
Fax Number	:	707-379-7997

Provider Business Practice Location Address
First Line	:	3535 RANDOLPH RD
Second Line	:	SUITE 202
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1032
Country	:	US
Telephone Number	:	704-379-7990
Fax Number	:	707-379-7997

Authorized Official
Title or Position	:	CEO
Name	:	DR. STEPHEN M BRENAN
Credential	:	D.O.
Telephone Number	:	704-379-7990

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	08/22/2020

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Directions to “FIRST CHOICE CHIROPRACTIC AND WELLNESS CENTER ” Practice Location

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