Provider Demographics
NPI:1043411465
Name:MICHAEL G REGAN
Entity Type:Organization
Organization Name:MICHAEL G REGAN
Other - Org Name:MICHAEL REGAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-569-1212
Mailing Address - Street 1:105 CENTRAL AVE
Mailing Address - Street 2:SUITE300 B
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-3084
Mailing Address - Country:US
Mailing Address - Phone:843-569-1212
Mailing Address - Fax:843-569-1909
Practice Address - Street 1:105 CENTRAL AVE
Practice Address - Street 2:SUITE 300 B
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3084
Practice Address - Country:US
Practice Address - Phone:843-569-1212
Practice Address - Fax:843-569-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1171Medicaid
SCCH1171Medicaid
SCT860760281Medicare ID - Type Unspecified