Provider Demographics
NPI:1962043711
Name:UNIVERSITY CITY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:UNIVERSITY CITY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-300-4268
Mailing Address - Street 1:104 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:NC
Mailing Address - Zip Code:28073-9567
Mailing Address - Country:US
Mailing Address - Phone:704-300-4268
Mailing Address - Fax:
Practice Address - Street 1:8524 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3579
Practice Address - Country:US
Practice Address - Phone:704-568-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty