Provider Demographics
NPI:1366623563
Name:WHOLE PERSON HEALTH PC
Entity Type:Organization
Organization Name:WHOLE PERSON HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-837-2420
Mailing Address - Street 1:3315 SPRINGBANK LN STE 304
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3198
Mailing Address - Country:US
Mailing Address - Phone:704-837-2420
Mailing Address - Fax:704-246-5193
Practice Address - Street 1:3315 SPRINGBANK LN STE 304
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3198
Practice Address - Country:US
Practice Address - Phone:704-837-2420
Practice Address - Fax:704-246-5193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2455026Medicare PIN