Provider Demographics
NPI:1407286990
Name:CAROLINA SPORTS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CAROLINA SPORTS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOLLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:919-903-8727
Mailing Address - Street 1:201 S ESTES DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-7001
Mailing Address - Country:US
Mailing Address - Phone:919-903-8727
Mailing Address - Fax:919-903-8667
Practice Address - Street 1:201 S ESTES DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-7001
Practice Address - Country:US
Practice Address - Phone:919-903-8727
Practice Address - Fax:919-903-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCD387Medicare PIN