Provider Demographics
NPI:1699720219
Name:SHARP CHIROPRACTIC, PC
Entity type:Organization
Organization Name:SHARP CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-768-7227
Mailing Address - Street 1:4622 COUNTRY CLUB RD.
Mailing Address - Street 2:140
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-4616
Mailing Address - Country:US
Mailing Address - Phone:336-768-7227
Mailing Address - Fax:336-768-3802
Practice Address - Street 1:4622 COUNTRY CLUB RD.
Practice Address - Street 2:STE. 140
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4616
Practice Address - Country:US
Practice Address - Phone:336-768-7227
Practice Address - Fax:336-768-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19279111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty