Provider Demographics
NPI:1922340447
Name:PETTY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PETTY CHIROPRACTIC, PLLC
Other - Org Name:CAROLINA CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-214-2020
Mailing Address - Street 1:1295 OLD US 1
Mailing Address - Street 2:SUITE F
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387
Mailing Address - Country:US
Mailing Address - Phone:910-246-2099
Mailing Address - Fax:910-246-2098
Practice Address - Street 1:1295 OLD US 1
Practice Address - Street 2:SUITE F
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-246-2099
Practice Address - Fax:910-246-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4185111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty