Provider Demographics
NPI:1962578716
Name:SOUTH CHARLOTTE CHIROPRACTIC PLLC
Entity type:Organization
Organization Name:SOUTH CHARLOTTE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRATOR OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:RANDAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-841-1122
Mailing Address - Street 1:PO BOX 78530
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28271
Mailing Address - Country:US
Mailing Address - Phone:704-841-1122
Mailing Address - Fax:704-841-1133
Practice Address - Street 1:8179 ARDREY KELL RD
Practice Address - Street 2:STE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277
Practice Address - Country:US
Practice Address - Phone:704-841-1122
Practice Address - Fax:704-841-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC80985G7Medicaid
U80421Medicare UPIN
NC80985G7Medicaid