Organization Active NPI

McNulty Chiropractic, PLLC

  • Chiropractor
  • Concord, NC
National Provider Identifier
1679774061
Registry record updated Dec 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
3351 Issued in NC
Legal business name
MCNULTY CHIROPRACTIC, PLLC
Practice address
980 Copperfield Blvd NE
Concord, NC 28025-2452
Phone
(704) 788-1895
Fax
(704) 795-7959
NPI assigned
May 31, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2013

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

Authorized official

Name
Christopher W McNultyNPI 1194751131
Title
Owner
Phone
(704) 788-1895

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X 3351 NC Primary

Addresses

Primary practice location

980 Copperfield Blvd NE
Concord, NC 28025-2452

Mailing address

980 Copperfield Blvd NE
Concord, NC 28025-2452
Phone (704) 788-1895

Other identifiers 5

IdentifierTypeStateIssuer
085V6OtherNCBCBS
809652OtherNCPARTNERS
9398540OtherNCPHCS
30-0002163OtherNCCORVEL
5903174MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080604000269 NC Part B Supplier - Clinic/Group Practice 3476623364 Receives reassigned benefits from 3 practitioners
Practice locations: Concord, NC

National Provider Directory

National Provider Directory

Locations

980 Copperfield Blvd NE
Concord, NC 28025
Phone (704) 788-1895

932 Copperfield Blvd NE
Concord, NC 28025
Phone (704) 788-1895

994 Copperfield Blvd NE
Concord, NC 28025
Phone (704) 565-0262

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387411200000",
    "number": "1679774061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "980 COPPERFIELD BLVD NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252452",
            "telephone_number": "704-788-1895",
            "fax_number": "704-795-7959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "980 COPPERFIELD BLVD NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252452",
            "telephone_number": "704-788-1895",
            "fax_number": "704-795-7959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCNULTY CHIROPRACTIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-31",
        "last_updated": "2013-12-19",
        "status": "A",
        "authorized_official_last_name": "MCNULTY",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "704-788-1895"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "NC",
            "license": "3351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "085V6",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "809652",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "9398540",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORVEL",
            "identifier": "30-0002163",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5903174",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2013; 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.