Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 111NS0005X | Chiropractor | Sports Physician | | | No |
| 2 | 111N00000X | Chiropractor | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 085A6 | OTHER | NORTH CAROLINA | BCBS INDIVIDUAL |
| 2 | 53164 | OTHER | NORTH CAROLINA | AWHN |
| 3 | U85916 | MEDICARE UPIN | NORTH CAROLINA | |
| 4 | 208640 | OTHER | NORTH CAROLINA | QUAILCHOICE |
| 5 | 2454232 | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | MEDCARE GROUP |
| 6 | 5909823002 | OTHER | NORTH CAROLINA | CIGNA PAL |
| 7 | 561971088 | OTHER | NORTH CAROLINA | CNC TIN |
| 8 | 0194L | OTHER | NORTH CAROLINA | CNC (BCBS) |
| 9 | 4881 | OTHER | NORTH CAROLINA | PARTNERS GROUP |
| 10 | 245402A | MEDICARE ID-TYPE UNSPECIFIED | NORTH CAROLINA | MEDCARE INDIVIDUAL |
| 11 | 617420 | OTHER | NORTH CAROLINA | ACN |
| 12 | 350053151 | OTHER | NORTH CAROLINA | RAILROAD MEDICARE |
| 13 | 42162996 | OTHER | NORTH CAROLINA | WAUSAU |
| 14 | 7741266 | OTHER | NORTH CAROLINA | AETNA |
| 15 | 43954 | OTHER | NORTH CAROLINA | PARTNERS INDIVIDUAL |
| 16 | 89085A6 | MEDICAID | NORTH CAROLINA | |
