Provider Demographics
NPI:1609829738
Name:CHARLOTTE CHIROPRACTIC CLINIC, P.A.
Entity Type:Organization
Organization Name:CHARLOTTE CHIROPRACTIC CLINIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-598-8040
Mailing Address - Street 1:537 WEST SUGAR CREEK ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-6159
Mailing Address - Country:US
Mailing Address - Phone:704-598-8040
Mailing Address - Fax:704-509-0915
Practice Address - Street 1:537 W SUGAR CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-6102
Practice Address - Country:US
Practice Address - Phone:704-598-8040
Practice Address - Fax:704-509-0915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08203OtherBCBSNC
NC8908203Medicaid
NC08203OtherBCBSNC
NC8908203Medicaid