Individual provider Active NPI

Kevin Mark Sharp, D.C.

  • Chiropractor
  • Winston Salem, NC
National Provider Identifier
1568458057
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1929 Issued in NC
Practice address
173 Jonestown Rd
Winston-Salem, NC 27104-4616
Phone
(336) 768-7227
Fax
(336) 768-3802
NPI assigned
Sep 21, 2005
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1929 NC Primary
Chiropractor 111N00000X 19279 CA

Addresses

Primary practice location

173 Jonestown Rd
Winston-Salem, NC 27104-4616

Mailing address

173 Jonestown Rd
Winston-Salem, NC 27104-4616
Phone (336) 768-7227

Other identifiers 1

IdentifierTypeStateIssuer
790279AMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080521000800 NC Practitioner - Chiropractic 9739258377 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1929NCMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Camel City Chiropractic PLLC Chiropractor CurrentSince Oct 5, 2023 Accepting new patients
FHC Winston Chiropractor PastSince Aug 1, 2008 Accepting new patients
Burke Street Chiropractic, PLLC Chiropractor PastSince Jul 1, 2019 Accepting new patients

Locations

4622 Country Club Rd
Ste 140
Winston Salem, NC 27104
Phone (336) 768-7227

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1568458057",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "173 JONESTOWN RD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271044616",
            "telephone_number": "336-768-7227",
            "fax_number": "336-768-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 JONESTOWN RD",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271044616",
            "telephone_number": "336-768-7227",
            "fax_number": "336-768-3802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARP",
        "first_name": "KEVIN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "1929",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "19279",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "790279A",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.