Provider Demographics
NPI:1538428347
Name:CAROLINA SPINAL CARE & LASER THERAPY CENTER PC
Entity type:Organization
Organization Name:CAROLINA SPINAL CARE & LASER THERAPY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:SCELFO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-775-7600
Mailing Address - Street 1:12201 N NC HIGHWAY 150
Mailing Address - Street 2:SUITE #4
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-9731
Mailing Address - Country:US
Mailing Address - Phone:336-775-7600
Mailing Address - Fax:336-775-7610
Practice Address - Street 1:12201 N NC HIGHWAY 150
Practice Address - Street 2:SUITE #4
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-9731
Practice Address - Country:US
Practice Address - Phone:336-775-7600
Practice Address - Fax:336-775-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2456007Medicare PIN