Provider Demographics
NPI:1154511418
Name:CHIROPRACTIC HEALTH & ACCIDENT CENTER
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH & ACCIDENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-408-0965
Mailing Address - Street 1:2547 MAIN ST
Mailing Address - Street 2:PO BOX 1147
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8845
Mailing Address - Country:US
Mailing Address - Phone:803-408-0965
Mailing Address - Fax:803-408-0966
Practice Address - Street 1:2547 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8845
Practice Address - Country:US
Practice Address - Phone:803-408-0965
Practice Address - Fax:803-408-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC958261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0958Medicaid
SCT236897513Medicare UPIN