Organization
OM SPA CHIROPRACTIC & WELLNESS,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN SCOTT EDMISTON D.C. (PRESIDENT)
(704) 342-1100
Entity
Organization
Contact information
Practice address
523 FENTON PL, CHARLOTTE, NC 28207-1919
(704) 302-1524
(980) 875-9531
Mailing address
523 FENTON PL, CHARLOTTE, NC 28207-1919
(704) 302-1524
(980) 875-9531
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89085M2
—
NC
Enumeration date
02/13/2008
Last updated
07/19/2012
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