Provider Demographics
NPI:1366465585
Name:FIRST CHOICE CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:FIRST CHOICE CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRENAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:704-379-7990
Mailing Address - Street 1:3535 RANDOLPH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1032
Mailing Address - Country:US
Mailing Address - Phone:704-379-7990
Mailing Address - Fax:707-379-7997
Practice Address - Street 1:3535 RANDOLPH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1032
Practice Address - Country:US
Practice Address - Phone:704-379-7990
Practice Address - Fax:707-379-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016GWOtherBCBS GROUP NUMBER
NC016GWOtherBCBS GROUP NUMBER