Provider Demographics
NPI:1134471956
Name:THEOBALD FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:THEOBALD FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:THEOBALD
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:843-849-3730
Mailing Address - Street 1:900 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6130
Mailing Address - Country:US
Mailing Address - Phone:843-849-3730
Mailing Address - Fax:
Practice Address - Street 1:900 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6130
Practice Address - Country:US
Practice Address - Phone:843-849-3730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty