Provider Demographics
NPI:1295393981
Name:NEW COVENANT ENTERPRISE, LLC
Entity Type:Organization
Organization Name:NEW COVENANT ENTERPRISE, LLC
Other - Org Name:CAROLINA WEST CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:C
Authorized Official - Last Name:VERCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-597-5099
Mailing Address - Street 1:1112 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-3445
Mailing Address - Country:US
Mailing Address - Phone:803-597-5099
Mailing Address - Fax:803-597-5106
Practice Address - Street 1:1112 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3445
Practice Address - Country:US
Practice Address - Phone:803-597-5099
Practice Address - Fax:803-597-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134575897OtherINDIVIDUAL NPI