Provider Demographics
NPI:1609581933
Name:SHALLOTTE CHIROPRACTIC BALANCE AND WELLNESS PLLC
Entity Type:Organization
Organization Name:SHALLOTTE CHIROPRACTIC BALANCE AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-264-1705
Mailing Address - Street 1:4465 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4451
Mailing Address - Country:US
Mailing Address - Phone:910-505-8680
Mailing Address - Fax:
Practice Address - Street 1:4465 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4451
Practice Address - Country:US
Practice Address - Phone:910-505-8680
Practice Address - Fax:910-612-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-20
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083616825OtherINDIVIDUAL NPI
NC89085H6Medicaid
NC085H6OtherBLUE CROSS/BLUE SHIELD