Provider Demographics
NPI:1932584067
Name:I HEART MY SPINE LLC
Entity Type:Organization
Organization Name:I HEART MY SPINE LLC
Other - Org Name:CORRECTIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WICKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:252-758-7583
Mailing Address - Street 1:4230 E 10TH STREET
Mailing Address - Street 2:SUITE G
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858
Mailing Address - Country:US
Mailing Address - Phone:252-758-7583
Mailing Address - Fax:252-624-0729
Practice Address - Street 1:4230 EAST TENTH STREET
Practice Address - Street 2:SUITE G
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-0838
Practice Address - Country:US
Practice Address - Phone:252-758-7583
Practice Address - Fax:252-624-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4026111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty