Provider Demographics
NPI:1821048497
Name:STOLDADDY INC.
Entity Type:Organization
Organization Name:STOLDADDY INC.
Other - Org Name:LUNDY CHIROPRACTIC AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-754-2225
Mailing Address - Street 1:4647 MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-1771
Mailing Address - Country:US
Mailing Address - Phone:910-754-2225
Mailing Address - Fax:910-754-2227
Practice Address - Street 1:4647 MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-1771
Practice Address - Country:US
Practice Address - Phone:910-754-2225
Practice Address - Fax:910-754-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2913111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2349765Medicare ID - Type UnspecifiedGROUP PROVIDER #