Provider Demographics
NPI:1114365202
Name:PRECISION CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:PRECISION CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-628-5353
Mailing Address - Street 1:3069 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4873
Mailing Address - Country:US
Mailing Address - Phone:843-628-5353
Mailing Address - Fax:843-557-1446
Practice Address - Street 1:3069 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4873
Practice Address - Country:US
Practice Address - Phone:843-628-5353
Practice Address - Fax:843-557-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3681111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA841984466Medicare PIN