Provider Demographics
NPI:1063823565
Name:CHARLES TOWNE CHIROPRACTIC
Entity Type:Organization
Organization Name:CHARLES TOWNE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:FERRENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-277-2750
Mailing Address - Street 1:152 CANNON ST STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29403-7700
Mailing Address - Country:US
Mailing Address - Phone:843-277-2750
Mailing Address - Fax:
Practice Address - Street 1:152 CANNON ST STE D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-7700
Practice Address - Country:US
Practice Address - Phone:843-277-2750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty