Provider Demographics
NPI:1235232711
Name:BATSON, MARY MOORE
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MOORE
Last Name:BATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:102 MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709-1618
Mailing Address - Country:US
Mailing Address - Phone:843-623-6300
Mailing Address - Fax:
Practice Address - Street 1:102 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709-1618
Practice Address - Country:US
Practice Address - Phone:843-623-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor