Provider Demographics
NPI:1144586272
Name:CITY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CITY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SCHOLTISEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-587-0078
Mailing Address - Street 1:14142 RIVERGATE PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-8906
Mailing Address - Country:US
Mailing Address - Phone:704-587-0078
Mailing Address - Fax:704-587-0071
Practice Address - Street 1:14142 RIVERGATE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-8906
Practice Address - Country:US
Practice Address - Phone:704-587-0078
Practice Address - Fax:704-587-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty