Provider Demographics
NPI:1134469943
Name:COTSWOLD CHIROPRACTIC CENTER PLLC
Entity Type:Organization
Organization Name:COTSWOLD CHIROPRACTIC CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-442-0032
Mailing Address - Street 1:319 S SHARON AMITY RD
Mailing Address - Street 2:210
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2898
Mailing Address - Country:US
Mailing Address - Phone:704-442-0032
Mailing Address - Fax:
Practice Address - Street 1:319 S SHARON AMITY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2898
Practice Address - Country:US
Practice Address - Phone:704-442-0032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty