Provider Demographics
NPI:1164692372
Name:ROFF AND SHERMAN CHIROPRACTIC
Entity Type:Organization
Organization Name:ROFF AND SHERMAN CHIROPRACTIC
Other - Org Name:ROFF AND SHERMAN CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CA
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:EDMUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-774-3621
Mailing Address - Street 1:200 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2516
Mailing Address - Country:US
Mailing Address - Phone:843-774-3621
Mailing Address - Fax:843-774-6456
Practice Address - Street 1:200 E ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2516
Practice Address - Country:US
Practice Address - Phone:843-774-3621
Practice Address - Fax:843-774-6456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0506111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0506Medicaid