Provider Demographics
NPI:1043289754
Name:DUNLAP, TINA THOMAS (DC)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:THOMAS
Last Name:DUNLAP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 MIDDLETON ST
Mailing Address - Street 2:PO BOX 534
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4885
Mailing Address - Country:US
Mailing Address - Phone:803-534-0964
Mailing Address - Fax:803-534-2517
Practice Address - Street 1:1615 MIDDLETON ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4885
Practice Address - Country:US
Practice Address - Phone:803-534-0964
Practice Address - Fax:803-534-2517
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1431 GCH1221Medicare ID - Type UnspecifiedMEDICARE