Provider Demographics
NPI:1083805972
Name:PEE DEE CHIROPRACTIC FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:PEE DEE CHIROPRACTIC FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PORZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-665-5505
Mailing Address - Street 1:PO BOX 12339
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29504-2339
Mailing Address - Country:US
Mailing Address - Phone:843-665-5505
Mailing Address - Fax:843-665-7447
Practice Address - Street 1:500 PAMPLICO HWY
Practice Address - Street 2:SUITE F
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6012
Practice Address - Country:US
Practice Address - Phone:843-665-5505
Practice Address - Fax:843-665-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2354111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2354Medicaid