Provider Demographics
NPI:1205029063
Name:COMPEL, COLLEEN LYNN (DC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:LYNN
Last Name:COMPEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:LYNN
Other - Last Name:COMPEL-PICKERING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:5200 PARK RD
Mailing Address - Street 2:SUITE 207-E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209
Mailing Address - Country:US
Mailing Address - Phone:539-302-4476
Mailing Address - Fax:
Practice Address - Street 1:5200 PARK RD
Practice Address - Street 2:SUITE 207-E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209
Practice Address - Country:US
Practice Address - Phone:539-302-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3286111N00000X
NC3748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB459Medicaid