Provider Demographics
NPI:1568458057
Name:SHARP, KEVIN MARK (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MARK
Last Name:SHARP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 JONESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4616
Mailing Address - Country:US
Mailing Address - Phone:336-768-7227
Mailing Address - Fax:336-768-3802
Practice Address - Street 1:173 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4616
Practice Address - Country:US
Practice Address - Phone:336-768-7227
Practice Address - Fax:336-768-3802
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1929111N00000X
CA19279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790279AMedicaid
NC790279AMedicaid
NC2448691AMedicare ID - Type Unspecified