Provider Demographics
NPI:1700066727
Name:COMPEL CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:COMPEL CHIROPRACTIC, PLLC
Other - Org Name:COMPEL CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:COMPEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:539-302-4476
Mailing Address - Street 1:5200 PARK RD
Mailing Address - Street 2:SUITE 207-E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209
Mailing Address - Country:US
Mailing Address - Phone:539-302-4476
Mailing Address - Fax:
Practice Address - Street 1:5200 PARK RD
Practice Address - Street 2:SUITE 207-E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209
Practice Address - Country:US
Practice Address - Phone:539-302-4476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3748111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB459Medicaid