Provider Demographics
NPI:1922310754
Name:PARK ROAD HEALTH AND WELLNESS INC
Entity Type:Organization
Organization Name:PARK ROAD HEALTH AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOZJAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-523-2367
Mailing Address - Street 1:4312 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2271
Mailing Address - Country:US
Mailing Address - Phone:704-523-2367
Mailing Address - Fax:704-523-9937
Practice Address - Street 1:4312 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2271
Practice Address - Country:US
Practice Address - Phone:704-523-2367
Practice Address - Fax:704-523-9937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4049111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty