Provider Demographics
NPI:1972858405
Name:EXODUS CHIROPRACTIC CHARLOTTE PLLC
Entity Type:Organization
Organization Name:EXODUS CHIROPRACTIC CHARLOTTE PLLC
Other - Org Name:EXODUS CHIROPRACTIC INTERNATIONAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:MAHAFFY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-584-9299
Mailing Address - Street 1:1595 COLD CREEK PL
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3646
Mailing Address - Country:US
Mailing Address - Phone:810-841-3933
Mailing Address - Fax:
Practice Address - Street 1:15940 NORTHCROSS DR
Practice Address - Street 2:STE B
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-5062
Practice Address - Country:US
Practice Address - Phone:704-584-9299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty