Provider Demographics
NPI:1366962623
Name:CAROLINA CHIROPRACTIC GROUP PLLC
Entity type:Organization
Organization Name:CAROLINA CHIROPRACTIC GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-482-0135
Mailing Address - Street 1:145 W DIXON BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28152-6546
Mailing Address - Country:US
Mailing Address - Phone:704-482-0135
Mailing Address - Fax:704-482-0155
Practice Address - Street 1:145 W DIXON BLVD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-6546
Practice Address - Country:US
Practice Address - Phone:704-482-0135
Practice Address - Fax:704-710-8037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-27
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2259111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty