Provider Demographics
NPI:1306356845
Name:FOUNDATION FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FOUNDATION FAMILY CHIROPRACTIC, LLC
Other - Org Name:ELITE FAMILY CHIROPRACTIC OF CHARLESTON, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-955-0406
Mailing Address - Street 1:455 OLD TROLLEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5669
Mailing Address - Country:US
Mailing Address - Phone:843-851-2417
Mailing Address - Fax:
Practice Address - Street 1:455 OLD TROLLEY RD STE A
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5669
Practice Address - Country:US
Practice Address - Phone:843-851-2417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty