Provider Demographics
NPI:1831100056
Name:PARADIGM CARE GROUP PA
Entity Type:Organization
Organization Name:PARADIGM CARE GROUP PA
Other - Org Name:DYNAMIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:T
Authorized Official - Last Name:COX
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:704-525-6288
Mailing Address - Street 1:5215 SOUTH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-2771
Mailing Address - Country:US
Mailing Address - Phone:704-525-6288
Mailing Address - Fax:704-525-6384
Practice Address - Street 1:5215 SOUTH BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-2771
Practice Address - Country:US
Practice Address - Phone:704-525-6288
Practice Address - Fax:704-525-6384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2468111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7211998Medicaid
NC790104HMedicaid
017U5OtherBLUECROSS BLUESHIELD
0104HOtherBLUECROSS BLUESHIELD
2454008Medicare ID - Type Unspecified
NC6271100001Medicare NSC