Provider Demographics
NPI:1659156388
Name:CAROLINA CHIROPRACTIC GROUP OF GASTONIA PLLC
Entity Type:Organization
Organization Name:CAROLINA CHIROPRACTIC GROUP OF GASTONIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:704-482-0135
Mailing Address - Street 1:145 W DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6546
Mailing Address - Country:US
Mailing Address - Phone:704-482-0135
Mailing Address - Fax:704-710-8037
Practice Address - Street 1:528 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4450
Practice Address - Country:US
Practice Address - Phone:704-867-1010
Practice Address - Fax:704-710-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty