| Organization Name: | INDIAN TRAIL SPECIFIC CHIROPRACTIC INC |
| NPI Number: | 1073528899 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORINNE EASTERLING WEAVER (PRESIDENT) |
| Mailing Address: | 14015 Independence Blvd Ste D Indian Trail |
| State: | NC US |
| Postal Code: | 280799668 |
| Phone Number: | 7048821488 |
| Fax Number: | 7048821448 |
| NPI Enumeration Date: | 07/30/2006 |
| NPI Last Update Date: | 03/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111NT0100X |
| License Number: | 3225 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | Thermography |
| Taxonomy Definition: | |