Organization
MYERS PARK CHIROPRACTIC PA
Active
Other names
CHARLOTTE WELLNESS CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN WILLIAM GOTRO D.C. (OWNER)
(704) 343-0208
Entity
Organization
Contact information
Practice address
1000 QUEENS RD, SUITE 2, CHARLOTTE, NC 28207-1860
(704) 343-0208
(704) 343-0275
Mailing address
2725 COTTON PLANTER LN, CHARLOTTE, NC 28270-3764
(704) 577-9028
(704) 343-0275
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
2603
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0842Y
BCBS PROVIDER NUMBER
NC
01
—
1396757027
INDIVIDUAL NPI NUMBER
NC
01
—
1730394529
GROUP NPI
NC
05
—
890842Y
—
NC
Enumeration date
05/14/2007
Last updated
03/18/2015
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