Provider Demographics
NPI: | 1033214960 |
---|---|
Name: | FAMILY CHIROPRACTIC CLINIC |
Entity Type: | Organization |
Organization Name: | FAMILY CHIROPRACTIC CLINIC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KENNETH |
Authorized Official - Middle Name: | CHARLES |
Authorized Official - Last Name: | STRATTON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 864-963-8186 |
Mailing Address - Street 1: | PO BOX 425 |
Mailing Address - Street 2: | |
Mailing Address - City: | SIMPSONVILLE |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29681-0425 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 864-963-8186 |
Mailing Address - Fax: | 864-228-2349 |
Practice Address - Street 1: | 311 W GEORGIA RD |
Practice Address - Street 2: | |
Practice Address - City: | SIMPSONVILLE |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29681-2401 |
Practice Address - Country: | US |
Practice Address - Phone: | 864-963-8186 |
Practice Address - Fax: | 864-228-2349 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-09-14 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 637 | 111N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 111N00000X | Chiropractic Providers | Chiropractor | Group - Single Specialty |