MEDICARE: TOPTEAM FITNESS ACADEMY, INC.

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	4020	NC

General Provider Information

NPI Number	:	1457629313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOPTEAM FITNESS ACADEMY, INC.

Provider Business Mailing Address
First Line	:	201 MCCULLOUGH DR
Second Line	:	SUITE 160
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3577
Country	:	US
Telephone Number	:	980-207-0970
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 MCCULLOUGH DR
Second Line	:	SUITE 160
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-3577
Country	:	US
Telephone Number	:	980-207-0970
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JASON W LINDSAY
Credential	:
Telephone Number	:	805-886-1402

Provider Enumeration Date	:	12/07/2011
Last Update Date	:	06/23/2013

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