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Organization

SHALLOTTE CHIROPRACTIC BALANCE AND WELLNESS PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. AGNES REGINA FREEMAN DC (OWNER/PRESIDENT)
(910) 264-1705
Entity
Organization

Contact information

Practice address
4465 MAIN ST, SHALLOTTE, NC 28470-4451
(910) 505-8680
(910) 612-6002
Mailing address
4465 MAIN ST, SHALLOTTE, NC 28470-4451
(910) 505-8680

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
085H6
BLUE CROSS/BLUE SHIELD
NC
01
1083616825
INDIVIDUAL NPI
NC
05
89085H6
NC
Enumeration date
01/20/2023
Last updated
12/28/2023
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