Provider Demographics
NPI:1992977961
Name:CROWN POINT CLINIC OF CHIROPRACTIC P.A.
Entity type:Organization
Organization Name:CROWN POINT CLINIC OF CHIROPRACTIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-847-4797
Mailing Address - Street 1:1811 SARDIS RD N
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-1426
Mailing Address - Country:US
Mailing Address - Phone:704-847-4797
Mailing Address - Fax:704-847-4810
Practice Address - Street 1:1811 SARDIS RD N
Practice Address - Street 2:SUITE 206
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1426
Practice Address - Country:US
Practice Address - Phone:704-847-4797
Practice Address - Fax:704-847-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-30
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3422111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU79316Medicare UPIN
NCU86562Medicare UPIN