| |
9325 Center Lake Dr Ste 150 Charlotte NC 28216-0785 | |
(704) 494-4250 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 9325 Center Lake Dr Ste 150, Charlotte, North Carolina |
Authorized Official Name and Position | Charles Cole (CEO) |
Authorized Official Contact | 7044944250 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 681901 Charlotte NC 28216-0031 Ph: () - | 9325 Center Lake Dr Ste 150 Charlotte NC 28216-0785 Ph: (704) 494-4250 |
NPI Number | 1689410714 |
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Provider Enumeration Date | 07/08/2024 |
Last Update Date | 09/05/2024 |
Medicare PECOS PAC ID | 9234679333 |
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Medicare Enrollment ID | O20240904000920 |
Identifier | Type | State | Issuer |
---|---|---|---|
1689410714 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Charles Cole |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1659120996 PECOS PAC ID: 0143760249 Enrollment ID: I20240904001126 |
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