MEDICARE: CAROLINA CHIROPRACTIC CENTER P A

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	302R00000X	Health Maintenance Organization	1107	NC

General Provider Information

NPI Number	:	1386076693
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA CHIROPRACTIC CENTER P A

Provider Business Mailing Address
First Line	:	2007 W VANDALIA RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-7617
Country	:	US
Telephone Number	:	336-855-6316
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 W VANDALIA RD
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-7617
Country	:	US
Telephone Number	:	336-855-6316
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	GARY W MCKEEL
Credential	:	D.C.
Telephone Number	:	336-855-6316

Provider Enumeration Date	:	08/09/2013
Last Update Date	:	11/20/2013

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