Provider Demographics
NPI:1629490818
Name:CHIRO CAROLINA FAMILY AND SPORTS CARE
Entity Type:Organization
Organization Name:CHIRO CAROLINA FAMILY AND SPORTS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WOODROW
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:828-598-0371
Mailing Address - Street 1:PO BOX 6225
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-6225
Mailing Address - Country:US
Mailing Address - Phone:828-598-0371
Mailing Address - Fax:828-598-0372
Practice Address - Street 1:174 BOLICK LN
Practice Address - Street 2:SUITE 102
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-3319
Practice Address - Country:US
Practice Address - Phone:828-598-0371
Practice Address - Fax:828-598-0372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty