Provider Demographics
NPI:1134141161
Name:QUATTLEBAUM, BRIAN E (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:QUATTLEBAUM
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 1:302A MIDLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8102
Mailing Address - Country:US
Mailing Address - Phone:843-552-8000
Mailing Address - Fax:843-552-0093
Practice Address - Street 1:302A MIDLAND PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8102
Practice Address - Country:US
Practice Address - Phone:843-552-8000
Practice Address - Fax:843-552-0093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3095111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3095Medicaid
SCV08083Medicare UPIN
SCCH3095Medicaid