NPIMap

Organization Active NPI

Carolina Sports, Spine & Wellness Center, PLLC

  • Chiropractor
  • Greensboro, NC
National Provider Identifier
1285056630
Registry record updated Jan 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
4274 Issued in NC
Legal business name
CAROLINA SPORTS, SPINE & WELLNESS CENTER, PLLC
Practice address
3150 N Elm St
Suite 103
Greensboro, NC 27408-3880
Phone
(336) 763-3756
Fax
(336) 763-3757
NPI assigned
Jan 19, 2014
Last updated
Jan 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2014

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

Authorized official

Name
Dr. Scott David Weaver, D.C.NPI 1417216839
Title
Sole Member
Phone
(419) 494-7169

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 4274 NC Primary

Addresses

Primary practice location

3150 N Elm St
Suite 103
Greensboro, NC 27408-3880

Mailing address

PO Box 13647
Greensboro, NC 27415-3647
Phone (336) 763-3756

Other identifiers 3

IdentifierTypeStateIssuer
12377167OtherNCCAQH
G236C2532528MedicaidNC
NC6179AOtherNCMEDICARE PTAN

National Provider Directory

National Provider Directory

Locations

3150 N Elm St
Ste 103
Greensboro, NC 27408
Phone (336) 763-3756

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1390089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390089600000",
    "number": "1285056630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 13647",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274153647",
            "telephone_number": "336-763-3756",
            "fax_number": "336-763-3757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3150 N ELM ST",
            "address_2": "SUITE 103",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274083880",
            "telephone_number": "336-763-3756",
            "fax_number": "336-763-3757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLINA SPORTS, SPINE & WELLNESS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-19",
        "last_updated": "2014-01-19",
        "status": "A",
        "authorized_official_last_name": "WEAVER",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "419-494-7169",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "4274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12377167",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G236C2532528",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "NC6179A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.