Provider Demographics
NPI:1164532156
Name:EVERETT GOLLWITZER, CARLA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:LEE
Last Name:EVERETT GOLLWITZER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W WADE HAMPTON BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-1325
Mailing Address - Country:US
Mailing Address - Phone:864-877-7221
Mailing Address - Fax:864-877-9295
Practice Address - Street 1:810 W WADE HAMPTON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1325
Practice Address - Country:US
Practice Address - Phone:864-877-7221
Practice Address - Fax:864-877-9295
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2975111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor