Organization
CAROLINA SPORTS, SPINE & WELLNESS CENTER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT DAVID WEAVER D.C. (SOLE MEMBER)
(419) 494-7169
Entity
Organization
Contact information
Practice address
3150 N ELM ST, SUITE 103, GREENSBORO, NC 27408-3880
(336) 763-3756
(336) 763-3757
Mailing address
PO BOX 13647, GREENSBORO, NC 27415-3647
(336) 763-3756
(336) 763-3757
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
4274
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12377167
CAQH
NC
05
—
G236C2532528
—
NC
01
—
NC6179A
MEDICARE PTAN
NC
Enumeration date
01/19/2014
Last updated
01/19/2014
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