Provider Demographics
NPI:1215191366
Name:DR. MARVIN T. ARNSDORFF, P.A.
Entity Type:Organization
Organization Name:DR. MARVIN T. ARNSDORFF, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ARNSDORFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-881-0046
Mailing Address - Street 1:1004 ANNA KNAPP BOULEVARD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3134
Mailing Address - Country:US
Mailing Address - Phone:843-881-0046
Mailing Address - Fax:843-881-0098
Practice Address - Street 1:1004 ANNA KNAPP BOULEVARD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3134
Practice Address - Country:US
Practice Address - Phone:843-881-0046
Practice Address - Fax:843-881-0098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1089Medicaid
SCT248870281Medicare PIN