Provider Demographics
NPI:1508015942
Name:CHIROPRACTIC WELLNESS CENTER, P.A.
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-658-9920
Mailing Address - Street 1:PO BOX 3822
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-3822
Mailing Address - Country:US
Mailing Address - Phone:704-658-9920
Mailing Address - Fax:704-658-9228
Practice Address - Street 1:386 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5928
Practice Address - Country:US
Practice Address - Phone:704-658-9920
Practice Address - Fax:704-658-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3117302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085JNOtherBCBS ID
NC89085JNMedicaid
NC085JNOtherBCBS ID