Carolina Concussion & Physical Medicine, PLLC

Primary specialty

Rehabilitation ChiropractorTaxonomy code 111NR0400X

License

4670 Issued in NC

Legal business name

CAROLINA CONCUSSION & PHYSICAL MEDICINE, PLLC

Practice address

120 Capcom Aveune
Suite 104
Wake Forest, NC 27587

Phone

(301) 922-6188

NPI assigned

Aug 18, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael S. Decriscio, DCNPI 1063541464

Title

Member

Phone

(301) 922-6188

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael S Decriscio, D.C.

  • Rehabilitation Chiropractor
  • Hagerstown, MD
  • NPI 1063541464

  NC

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526774400000",
    "number": "1124544499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 WOODCROSS WAY",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275878328",
            "telephone_number": "301-922-6188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 CAPCOM AVEUNE",
            "address_2": "SUITE 104",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "27587",
            "telephone_number": "301-922-6188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA CONCUSSION & PHYSICAL MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2018-05-20",
        "status": "A",
        "authorized_official_last_name": "DECRISCIO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "301-922-6188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NC",
            "license": "4670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carillon Assisted Living of Wake Forest LLC
• Caring Connections Pediatric Therapy PLLC
• Catherine Carmon
• Theresa McNeill Carmon
• Carolina Chiropractic and Consulting PLLC
• Carolina Diagnostics Inc
• Carolina Diagnostics, Inc
• Carolina Learn and Play LLC
• Carolina Massage Therapy
• Carolina School Services, LLC

• All providers in Wake Forest, NC
• Rehabilitation Chiropractor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.