Provider Demographics
NPI:1184728412
Name:DAVIDSON HEALTH ASSOC PA
Entity type:Organization
Organization Name:DAVIDSON HEALTH ASSOC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-644-0700
Mailing Address - Street 1:428 S MAIN ST
Mailing Address - Street 2:STE D
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036
Mailing Address - Country:US
Mailing Address - Phone:704-655-0700
Mailing Address - Fax:704-655-0701
Practice Address - Street 1:428 S MAIN ST
Practice Address - Street 2:STE D
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-655-0700
Practice Address - Fax:704-655-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3004111N00000X
NC2960111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U86850Medicare UPIN
NC2333962Medicare ID - Type Unspecified