Provider Demographics
NPI:1083041354
Name:MT. PLEASANT CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MT. PLEASANT CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:STAMEGNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS, DC
Authorized Official - Phone:843-881-1242
Mailing Address - Street 1:1321 CHUCK DAWLEY BLVD
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7304
Mailing Address - Country:US
Mailing Address - Phone:843-881-1242
Mailing Address - Fax:843-881-1242
Practice Address - Street 1:1321 CHUCK DAWLEY BLVD
Practice Address - Street 2:SUITE # 104
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7304
Practice Address - Country:US
Practice Address - Phone:843-881-1242
Practice Address - Fax:843-881-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-02
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20028425111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT235940281Medicare PIN