Provider Demographics
NPI:1629151923
Name:GREGORY P HAUGHTON DC PA
Entity Type:Organization
Organization Name:GREGORY P HAUGHTON DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-541-6000
Mailing Address - Street 1:10110 PATRICK HENRY LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8818
Mailing Address - Country:US
Mailing Address - Phone:704-541-6000
Mailing Address - Fax:704-541-3350
Practice Address - Street 1:6406 CARMEL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8061
Practice Address - Country:US
Practice Address - Phone:704-541-6000
Practice Address - Fax:704-541-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1740111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890847-AMedicaid
NC890847-AMedicaid
T98318Medicare UPIN