Provider Demographics
NPI:1508110388
Name:AMY M GUINN
Entity Type:Organization
Organization Name:AMY M GUINN
Other - Org Name:THE DOC SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-598-5446
Mailing Address - Street 1:1981 J N PEASE PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4545
Mailing Address - Country:US
Mailing Address - Phone:704-598-5446
Mailing Address - Fax:
Practice Address - Street 1:1981 J N PEASE PL
Practice Address - Street 2:SUITE 103
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4545
Practice Address - Country:US
Practice Address - Phone:704-598-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-01
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU95235Medicare UPIN