Provider Demographics
NPI:1326306424
Name:JAMES ISLAND FAMILY CHIROPRACTIC, LLC.
Entity Type:Organization
Organization Name:JAMES ISLAND FAMILY CHIROPRACTIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAUD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-795-1999
Mailing Address - Street 1:1939 MAYBANK HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2114
Mailing Address - Country:US
Mailing Address - Phone:843-795-1999
Mailing Address - Fax:843-795-1981
Practice Address - Street 1:1939 MAYBANK HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2114
Practice Address - Country:US
Practice Address - Phone:843-795-1999
Practice Address - Fax:843-795-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1609932953OtherINDIVIDUAL NPI