Provider Demographics
NPI:1497852180
Name:VOSWINKEL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:VOSWINKEL CHIROPRACTIC, INC.
Other - Org Name:GATEWAY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTOLD
Authorized Official - Middle Name:JOHANN
Authorized Official - Last Name:VOSWINKEL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:704-388-1960
Mailing Address - Street 1:120 NORTH CEDAR STREET
Mailing Address - Street 2:SUITE 725
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1354
Mailing Address - Country:US
Mailing Address - Phone:704-338-1960
Mailing Address - Fax:704-338-1970
Practice Address - Street 1:120 N CEDAR ST
Practice Address - Street 2:SUITE 725
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1292
Practice Address - Country:US
Practice Address - Phone:704-338-1960
Practice Address - Fax:704-338-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2726111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890838RMedicaid
NC890838RMedicaid