Provider Demographics
NPI:1295831246
Name:CHEUVRONT CLINIC OF CHIROPRACTIC & SPORTS MEDICINE INC
Entity Type:Organization
Organization Name:CHEUVRONT CLINIC OF CHIROPRACTIC & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:CHEUVRONT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-841-2200
Mailing Address - Street 1:9940 MONROE ROAD
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5347
Mailing Address - Country:US
Mailing Address - Phone:704-841-2200
Mailing Address - Fax:704-841-2534
Practice Address - Street 1:9940 MONROE ROAD
Practice Address - Street 2:SUITE # 101
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5347
Practice Address - Country:US
Practice Address - Phone:704-841-2200
Practice Address - Fax:704-841-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2128111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0872EOtherBLUE CROSS BLUE SHIELD
NC5315633OtherAETNA
NC890872EMedicaid
NC0872EOtherBLUE CROSS BLUE SHIELD
U02481Medicare UPIN