Provider Demographics
NPI:1679774061
Name:MCNULTY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:MCNULTY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-788-1895
Mailing Address - Street 1:980 COPPERFIELD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2452
Mailing Address - Country:US
Mailing Address - Phone:704-788-1895
Mailing Address - Fax:704-795-7959
Practice Address - Street 1:980 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2452
Practice Address - Country:US
Practice Address - Phone:704-788-1895
Practice Address - Fax:704-795-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC085V6OtherBCBS
NC809652OtherPARTNERS
NC9398540OtherPHCS
NC30-0002163OtherCORVEL
NC5903174Medicaid
NC2348968Medicare PIN
NC809652OtherPARTNERS