Provider Demographics
NPI:1205934775
Name:CAROLINA CHIROPRACTIC & WELLNESS CENTER
Entity type:Organization
Organization Name:CAROLINA CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:SHIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-892-1010
Mailing Address - Street 1:17115 KENTON DR
Mailing Address - Street 2:SUITE 206 A
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5645
Mailing Address - Country:US
Mailing Address - Phone:704-892-1010
Mailing Address - Fax:704-892-1074
Practice Address - Street 1:17115 KENTON DR
Practice Address - Street 2:SUITE 206 A
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5645
Practice Address - Country:US
Practice Address - Phone:704-892-1010
Practice Address - Fax:704-892-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017V7OtherBLUE CROSS BLUE SHIELD
NC017V7OtherBLUE CROSS BLUE SHIELD