Provider Demographics
NPI:1003108994
Name:FUNCTION AND PERFORMANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:FUNCTION AND PERFORMANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-783-8877
Mailing Address - Street 1:601 S KINGS DR STE F
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3089
Mailing Address - Country:US
Mailing Address - Phone:704-370-7775
Mailing Address - Fax:704-370-7776
Practice Address - Street 1:601 S KINGS DR STE F
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3089
Practice Address - Country:US
Practice Address - Phone:704-370-7775
Practice Address - Fax:704-370-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty