Provider Demographics
NPI:1730320524
Name:SCHOLTISEK, JARED (DC)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:SCHOLTISEK
Suffix:
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 1:14142 RIVERGATE PKWY
Mailing Address - Street 2:SUIRE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-8906
Mailing Address - Country:US
Mailing Address - Phone:704-587-0078
Mailing Address - Fax:704-587-0071
Practice Address - Street 1:14142 RIVERGATE PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-8906
Practice Address - Country:US
Practice Address - Phone:704-587-0078
Practice Address - Fax:704-587-0071
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3936OtherSTATE LICENSE NUMBER