Provider Demographics
NPI:1083791388
Name:TRYGGESTAD, KENNETH ERIC (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ERIC
Last Name:TRYGGESTAD
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:PO BOX 1817
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-1817
Mailing Address - Country:US
Mailing Address - Phone:803-319-1774
Mailing Address - Fax:803-661-9221
Practice Address - Street 1:800 COLUMBIANA DR STE 100
Practice Address - Street 2:STE. H
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7782
Practice Address - Country:US
Practice Address - Phone:803-781-8100
Practice Address - Fax:803-781-7200
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3401111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor