Provider Demographics
NPI:1912076134
Name:CAROLINA SPINE AND REHAB
Entity Type:Organization
Organization Name:CAROLINA SPINE AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GUINN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-598-5446
Mailing Address - Street 1:3716 W WT HARRIS BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8507
Mailing Address - Country:US
Mailing Address - Phone:704-598-5446
Mailing Address - Fax:704-598-5774
Practice Address - Street 1:3716 W WT HARRIS BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8507
Practice Address - Country:US
Practice Address - Phone:704-598-5446
Practice Address - Fax:704-598-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID