Provider Demographics
NPI:1609429281
Name:COMBINED CHIROPRACTIC & ACUPUNCTURE, PLLC
Entity Type:Organization
Organization Name:COMBINED CHIROPRACTIC & ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANTONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:980-444-0060
Mailing Address - Street 1:115 COMMONS DR STE D
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9264
Mailing Address - Country:US
Mailing Address - Phone:980-444-0060
Mailing Address - Fax:980-444-6860
Practice Address - Street 1:115 COMMONS DR STE D
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9264
Practice Address - Country:US
Practice Address - Phone:631-721-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty