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NPI Code Detail

MEDICARE: DR. MARK JICOV GHALI MD, DC

MEDICARE: DR. MARK JICOV GHALI MD, DC
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
1111N00000XChiropractorCH11793FL
2390200000XStudent in an Organized Health Care Education/Training Program
3111N00000XChiropractorCHIR009029GA

General Provider Information

NPI Number : 1730424268
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK JICOV GHALI MD, DC
Provider Business Mailing Address
First Line : 270 COPPERFIELD BLVD NE STE 202
Second Line :
City : CONCORD
State : NC
Zip : 28025-2441
Country : US
Telephone Number : 704-721-2060
Fax Number :
Provider Business Practice Location Address
First Line : 270 COPPERFIELD BLVD NE STE 202
Second Line :
City : CONCORD
State : NC
Zip : 28025-2441
Country : US
Telephone Number : 704-721-2060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2012
Last Update Date : 06/22/2026

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