Provider Demographics
NPI:1043373491
Name:MIGNANO, SALVATORE (DC)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:
Last Name:MIGNANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 FOLLY RD
Mailing Address - Street 2:STE C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3900
Mailing Address - Country:US
Mailing Address - Phone:843-762-2386
Mailing Address - Fax:843-795-9871
Practice Address - Street 1:914 FOLLY RD
Practice Address - Street 2:STE C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3900
Practice Address - Country:US
Practice Address - Phone:843-762-2386
Practice Address - Fax:843-795-9871
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2721111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2721Medicaid
SCCH2721Medicaid
SC8209Medicare ID - Type UnspecifiedPROV #