Provider Demographics
NPI:1811360803
Name:IHM SPORTS MEDICINE
Entity Type:Organization
Organization Name:IHM SPORTS MEDICINE
Other - Org Name:LT ENTERPRISE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/SPORTS MEDICINE CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FAISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:855-590-9527
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-1146
Mailing Address - Country:US
Mailing Address - Phone:855-590-9527
Mailing Address - Fax:
Practice Address - Street 1:5490 S MIAMI BLVD APT 207
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-8284
Practice Address - Country:US
Practice Address - Phone:855-590-9527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4283111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty