Provider Demographics
NPI:1659488872
Name:GOTRO, HUGH CHARLES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:HUGH
Middle Name:CHARLES
Last Name:GOTRO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13803 HIGHWAY 74 STE E
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7680
Mailing Address - Country:US
Mailing Address - Phone:704-882-0192
Mailing Address - Fax:704-882-0612
Practice Address - Street 1:13803 HIGHWAY 74 STE E
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-7680
Practice Address - Country:US
Practice Address - Phone:704-882-0192
Practice Address - Fax:704-882-0612
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2080111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908423Medicaid
NCU53015Medicare UPIN
NC5908423Medicaid