1205934775 NPI number — CAROLINA CHIROPRACTIC & WELLNESS CENTER

Table of content: DR. DAVID PHILIP FRICK D.O. (NPI 1356383004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205934775 NPI number — CAROLINA CHIROPRACTIC & WELLNESS CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINA CHIROPRACTIC & WELLNESS CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205934775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17115 KENTON DR
Provider Second Line Business Mailing Address:
SUITE 206 A
Provider Business Mailing Address City Name:
CORNELIUS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28031-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-892-1010
Provider Business Mailing Address Fax Number:
704-892-1074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17115 KENTON DR
Provider Second Line Business Practice Location Address:
SUITE 206 A
Provider Business Practice Location Address City Name:
CORNELIUS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28031-5645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-892-1010
Provider Business Practice Location Address Fax Number:
704-892-1074
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHIPLEY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-892-1010

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017V7 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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