Organization
DYNAMIC HEALTH AND PAIN MANAGEMENT, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEIDI COX (SECRETARY/TREASURER)
(704) 525-6288
Entity
Organization
Contact information
Practice address
4707 SOUTH BLVD, CHARLOTTE, NC 28217-2117
(704) 525-6288
(704) 525-6384
Mailing address
4707 SOUTH BLVD, CHARLOTTE, NC 28217-2117
(704) 525-6288
(704) 525-6384
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
—
—
208D00000X
General Practice Physician
Primary
9900407
NC
208VP0000X
Pain Medicine Physician
—
—
363L00000X
Nurse Practitioner
222692
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6558080001
MEDICARE DME PTAN
NC
Enumeration date
05/18/2011
Last updated
05/09/2017
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