Provider Demographics
NPI:1194751131
Name:MCNULTY, CHRISTOPHER WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 COPPERFIELD BLVD NE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2452
Mailing Address - Country:US
Mailing Address - Phone:704-788-1895
Mailing Address - Fax:704-795-7959
Practice Address - Street 1:980 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2452
Practice Address - Country:US
Practice Address - Phone:704-788-1895
Practice Address - Fax:704-795-7959
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC30-0002140OtherCORVEL
NC5903174Medicaid
NC9398540OtherPHCS
NC085V6OtherBCBS
V07160Medicare UPIN
NC30-0002140OtherCORVEL