Organization
CAROLINA CONCUSSION & PHYSICAL MEDICINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL S. DECRISCIO DC (MEMBER)
(301) 922-6188
Entity
Organization
Contact information
Practice address
120 CAPCOM AVEUNE, SUITE 104, WAKE FOREST, NC 27587
(301) 922-6188
Mailing address
7900 WOODCROSS WAY, WAKE FOREST, NC 27587-8328
(301) 922-6188
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
4670
NC
Other
Enumeration date
08/18/2017
Last updated
05/20/2018
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