Provider Demographics
NPI:1376690842
Name:CELEBRATION CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:CELEBRATION CHIROPRACTIC, P.C.
Other - Org Name:ADVANCED SPINAL FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:734-673-0135
Mailing Address - Street 1:444 WILLIAMSON RD STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9248
Mailing Address - Country:US
Mailing Address - Phone:734-673-0135
Mailing Address - Fax:704-663-5197
Practice Address - Street 1:444 WILLIAMSON RD STE C
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9248
Practice Address - Country:US
Practice Address - Phone:734-673-0135
Practice Address - Fax:704-663-5197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U93645Medicare UPIN