Provider Demographics
NPI:1336110618
Name:THE CHIROPRACTIC CENTER OF MAULDIN INC.
Entity Type:Organization
Organization Name:THE CHIROPRACTIC CENTER OF MAULDIN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAYES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:864-297-6270
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:MAULDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662-0982
Mailing Address - Country:US
Mailing Address - Phone:864-297-6270
Mailing Address - Fax:864-288-9010
Practice Address - Street 1:14C E BUTLER RD
Practice Address - Street 2:
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2402
Practice Address - Country:US
Practice Address - Phone:864-297-6270
Practice Address - Fax:864-288-9010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCHO883Medicaid
SCGCH302Medicaid