Provider Demographics
NPI:1245618917
Name:CARMICHAEL, MARY (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:PO BOX 969
Mailing Address - Street 2:
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-0969
Mailing Address - Country:US
Mailing Address - Phone:843-716-0546
Mailing Address - Fax:
Practice Address - Street 1:3626 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-0969
Practice Address - Country:US
Practice Address - Phone:843-716-0546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor