Provider Demographics
NPI:1396389060
Name:CORRECTIVE CHIROPRACTIC- CHARLESTON LLC
Entity Type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC- CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-355-5499
Mailing Address - Street 1:1217 IRON BRIDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7408
Mailing Address - Country:US
Mailing Address - Phone:843-972-3174
Mailing Address - Fax:
Practice Address - Street 1:1131 QUEENSBOROUGH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-5430
Practice Address - Country:US
Practice Address - Phone:843-972-3174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-05
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083194195OtherNPI
SC1235619354OtherNPI