Organization Active NPI

Om Spa Chiropractic & Wellness,P.C.

  • Chiropractor
  • Charlotte, NC
National Provider Identifier
1699943548
Registry record updated Sep 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
OM SPA CHIROPRACTIC & WELLNESS,P.C.
Practice address
1755 Lombardy Cir
Suite 100B
Charlotte, NC 28207-1919
Phone
(704) 302-1524
Fax
(980) 875-9531
NPI assigned
Feb 13, 2008
Last updated
Sep 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2026

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

Authorized official

Name
Dr. Bryan Scott Edmiston, D.C.NPI 1427142066
Title
President
Phone
(704) 342-1100

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
Chiropractor 111N00000X NU Primary

Addresses

Primary practice location

1755 Lombardy Cir
Suite 100B
Charlotte, NC 28207-1919

Mailing address

1755 Lombardy Cir
Suite 100B
Charlotte, NC 28207-1919
Phone (704) 302-1524

Other identifiers 1

IdentifierTypeStateIssuer
89085M2MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060502000183 NC Part B Supplier - Clinic/Group Practice 7214947514 Receives reassigned benefits from 2 practitioners
Practice locations: Charlotte, NC

National Provider Directory

National Provider Directory

Locations

325 Arlington Ave
Ste 510
Charlotte, NC 28203
Phone (704) 342-1100

523 Fenton Pl
Charlotte, NC 28207
Phone (704) 302-1524

Practitioners & affiliated clinicians

Practitioners 4

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": "1202860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789430400000",
    "number": "1699943548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1755 LOMBARDY CIR",
            "address_2": "SUITE 100B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071919",
            "telephone_number": "704-302-1524",
            "fax_number": "980-875-9531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1755 LOMBARDY CIR",
            "address_2": "SUITE 100B",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071919",
            "telephone_number": "704-302-1524",
            "fax_number": "980-875-9531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OM SPA CHIROPRACTIC & WELLNESS,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-13",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-14",
        "status": "A",
        "authorized_official_last_name": "EDMISTON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-342-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89085M2",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.