Provider Demographics
NPI:1003952730
Name:UNIVERSITY CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:UNIVERSITY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:USTIK
Authorized Official - Last Name:HOFFECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-548-8818
Mailing Address - Street 1:8929 JM KEYNES DR
Mailing Address - Street 2:#340
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3467
Mailing Address - Country:US
Mailing Address - Phone:704-548-8818
Mailing Address - Fax:
Practice Address - Street 1:8929 JM KEYNES DR
Practice Address - Street 2:#340
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3467
Practice Address - Country:US
Practice Address - Phone:704-548-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0834XOtherBCBS
NC0834XOtherBCBS