Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4661 | NC |
N | 111NS0005X | Chiropractic Sports Physician | 4661 | NC |
NPI | 1184076614 |
---|---|
Provider Name | Samantha Brooke Sellers |
First Address | Raleigh, NC 27609-7755 |
Second Address | Raleigh, NC 27603-8573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 23/09/2020 |