Provider Demographics
NPI:1033382312
Name:CHARLESTON CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:CHARLESTON CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:HOLDEN
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-971-5338
Mailing Address - Street 1:1571 MATHIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-9734
Mailing Address - Country:US
Mailing Address - Phone:843-971-5338
Mailing Address - Fax:843-971-5337
Practice Address - Street 1:1571 MATHIS FERRY RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-9734
Practice Address - Country:US
Practice Address - Phone:843-971-5338
Practice Address - Fax:843-971-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty