Provider Demographics
NPI:1487769568
Name:SPINA, JOLENE CECELIA (DC)
Entity type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:CECELIA
Last Name:SPINA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460S MAIN ST 302
Mailing Address - Street 2:PO BOX 2484
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8006
Mailing Address - Country:US
Mailing Address - Phone:704-655-0700
Mailing Address - Fax:704-626-2614
Practice Address - Street 1:428-D S. MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-655-0700
Practice Address - Fax:704-655-0701
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2962111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085EXMedicaid
NC2454216BMedicare PIN
U86850Medicare UPIN