Provider Demographics
NPI:1003178385
Name:CORE CHIROPRACTIC, INCORPORATION
Entity Type:Organization
Organization Name:CORE CHIROPRACTIC, INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-957-2222
Mailing Address - Street 1:518 E MAIN ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3668
Mailing Address - Country:US
Mailing Address - Phone:803-957-2222
Mailing Address - Fax:803-957-2223
Practice Address - Street 1:518 E MAIN ST
Practice Address - Street 2:SUITE #2
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3668
Practice Address - Country:US
Practice Address - Phone:803-957-2222
Practice Address - Fax:803-957-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2727111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty