Provider Demographics
NPI:1164562252
Name:MARION CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:MARION CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MENDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-423-4263
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-0833
Mailing Address - Country:US
Mailing Address - Phone:843-423-4263
Mailing Address - Fax:843-431-9400
Practice Address - Street 1:2516 EAST HWY 76
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:SC
Practice Address - Zip Code:29571
Practice Address - Country:US
Practice Address - Phone:843-423-4263
Practice Address - Fax:843-431-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2430111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC=========OtherTAX ID NO
GCH170Medicare ID - Type Unspecified
SC=========OtherTAX ID NO
SC7638Medicare ID - Type Unspecified