Provider Demographics
NPI:1417024597
Name:NORTHCUTT CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:NORTHCUTT CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:NORTHCUTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-752-8100
Mailing Address - Street 1:7221 PINEVILLE MATTHEWS RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-6175
Mailing Address - Country:US
Mailing Address - Phone:704-752-8100
Mailing Address - Fax:704-752-0240
Practice Address - Street 1:7221 PINEVILLE MATTHEWS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-6175
Practice Address - Country:US
Practice Address - Phone:704-752-8100
Practice Address - Fax:704-752-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2084111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU84015Medicare UPIN
NC2449085AMedicare ID - Type Unspecified