Provider Demographics
NPI:1114707577
Name:CAMEL CITY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CAMEL CITY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-768-7227
Mailing Address - Street 1:4622 COUNTRY CLUB RD STE 140
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3770
Mailing Address - Country:US
Mailing Address - Phone:336-768-7227
Mailing Address - Fax:336-768-3802
Practice Address - Street 1:4622 COUNTRY CLUB RD STE 140
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3770
Practice Address - Country:US
Practice Address - Phone:336-768-7227
Practice Address - Fax:336-768-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty