Provider Demographics
NPI:1710094651
Name:CAROLINA FAMILY CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:CAROLINA FAMILY CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LIMBANOVNOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-321-0656
Mailing Address - Street 1:8019 ARDREY KELL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-5716
Mailing Address - Country:US
Mailing Address - Phone:704-321-0656
Mailing Address - Fax:704-321-0092
Practice Address - Street 1:8019 ARDREY KELL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-5716
Practice Address - Country:US
Practice Address - Phone:704-321-0656
Practice Address - Fax:704-321-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2454040Medicare UPIN