Provider Demographics
NPI:1073835930
Name:COMPLEMENTARY CANCER CARE INC.
Entity Type:Organization
Organization Name:COMPLEMENTARY CANCER CARE INC.
Other - Org Name:INTEGRATIVE CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:FALKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:843-267-5060
Mailing Address - Street 1:86 JONATHAN LUCAS ST STE 117
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8900
Mailing Address - Country:US
Mailing Address - Phone:843-267-5060
Mailing Address - Fax:
Practice Address - Street 1:86 JONATHAN LUCAS ST SUITE 117
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8900
Practice Address - Country:US
Practice Address - Phone:843-267-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDE3296Medicaid
SC6349560001Medicare NSC