Provider Demographics
NPI:1730468919
Name:GASTONIA SPINE & SPORT, P.A.
Entity type:Organization
Organization Name:GASTONIA SPINE & SPORT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-990-8266
Mailing Address - Street 1:PO BOX 550307
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28055-0307
Mailing Address - Country:US
Mailing Address - Phone:704-990-8266
Mailing Address - Fax:
Practice Address - Street 1:1941 HOFFMAN RD STE 6
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7524
Practice Address - Country:US
Practice Address - Phone:704-990-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4142111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty