Provider Demographics
NPI:1235193830
Name:DOVE-KIDD, DEBBIE ROSE (DC)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:ROSE
Last Name:DOVE-KIDD
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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-0810
Mailing Address - Country:US
Mailing Address - Phone:843-797-3290
Mailing Address - Fax:843-797-8598
Practice Address - Street 1:105 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5354
Practice Address - Country:US
Practice Address - Phone:843-797-3290
Practice Address - Fax:843-797-8598
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC571112754OtherTAX ID #
SCCH0773Medicaid
SC571112754OtherTAX ID #