Provider Demographics
NPI:1558472274
Name:CHIROLINA CHIROPRACTIC PA
Entity Type:Organization
Organization Name:CHIROLINA CHIROPRACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTELEONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-598-4296
Mailing Address - Street 1:2720 E WT HARRIS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3929
Mailing Address - Country:US
Mailing Address - Phone:704-598-4296
Mailing Address - Fax:704-599-3916
Practice Address - Street 1:2720 E WT HARRIS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3929
Practice Address - Country:US
Practice Address - Phone:704-598-4296
Practice Address - Fax:704-599-3916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC381326OtherACN
NC0167XOtherBC/BS
NC890167XMedicaid
NC2450728Medicare ID - Type Unspecified