Provider Demographics
NPI:1629696398
Name:CAROLINA FUNCTIONAL NEUROLOGY CENTER
Entity Type:Organization
Organization Name:CAROLINA FUNCTIONAL NEUROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINDISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-725-2202
Mailing Address - Street 1:6511 CREEDMOOR RD STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1687
Mailing Address - Country:US
Mailing Address - Phone:919-725-2202
Mailing Address - Fax:
Practice Address - Street 1:6511 CREEDMOOR RD STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1687
Practice Address - Country:US
Practice Address - Phone:919-725-2202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty