Provider Demographics
NPI:1164488383
Name:HILTON HEAD CHIROPRACTIC NORTH LLC
Entity Type:Organization
Organization Name:HILTON HEAD CHIROPRACTIC NORTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WINNESTAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-815-3400
Mailing Address - Street 1:1 SHERIDAN DR
Mailing Address - Street 2:SHERIDAN PARK STE E
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910
Mailing Address - Country:US
Mailing Address - Phone:843-815-3400
Mailing Address - Fax:843-815-3402
Practice Address - Street 1:1 SHERIDAN DR
Practice Address - Street 2:SHERIDAN PARK STE E
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910
Practice Address - Country:US
Practice Address - Phone:843-815-3400
Practice Address - Fax:843-815-3402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2173111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5603Medicare ID - Type Unspecified
T46808Medicare UPIN