Provider Demographics
NPI:1972575314
Name:KANNAPOLIS CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:KANNAPOLIS CHIROPRACTIC, PC
Other - Org Name:KANNAPOLIS SPINE & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-938-1400
Mailing Address - Street 1:1909 S CANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6107
Mailing Address - Country:US
Mailing Address - Phone:704-938-1400
Mailing Address - Fax:704-938-5892
Practice Address - Street 1:1909 S CANNON BLVD
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6107
Practice Address - Country:US
Practice Address - Phone:704-938-1400
Practice Address - Fax:704-938-5892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2908111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085AXMedicaid
NCU85180Medicare UPIN
2343293Medicare PIN