Provider Demographics
NPI:1306008123
Name:CHRIS SMITH CHIROPRACTIC
Entity Type:Organization
Organization Name:CHRIS SMITH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DEWAINE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-552-8000
Mailing Address - Street 1:283 DORCHESTER MANOR BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-8108
Mailing Address - Country:US
Mailing Address - Phone:843-552-8000
Mailing Address - Fax:843-552-0093
Practice Address - Street 1:283 DORCHESTER MANOR BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-8108
Practice Address - Country:US
Practice Address - Phone:843-552-8000
Practice Address - Fax:843-552-0093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3348111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1073787206Medicaid