MEDICARE: TYVOLA CHIROPRACTIC CENTRE PA

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	983	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08502	OTHER	NC	BCBSNC
2	4317470	OTHER	NC	AETNA

General Provider Information

NPI Number	:	1750460085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TYVOLA CHIROPRACTIC CENTRE PA

Provider Business Mailing Address
First Line	:	9422 S TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6500
Country	:	US
Telephone Number	:	704-588-1792
Fax Number	:	704-588-2718

Provider Business Practice Location Address
First Line	:	9422 S TRYON ST
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-6500
Country	:	US
Telephone Number	:	704-588-1792
Fax Number	:	704-588-2718

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TUNIS CRAIG HUNT
Credential	:	DC
Telephone Number	:	704-588-1792

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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Practice Location Address:

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Directions to “TYVOLA CHIROPRACTIC CENTRE PA ” Practice Location

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