Provider Demographics
NPI:1407477979
Name:ST. GEORGE SPINE CENTER LLC
Entity Type:Organization
Organization Name:ST. GEORGE SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-970-3200
Mailing Address - Street 1:PO BOX 632
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477-0632
Mailing Address - Country:US
Mailing Address - Phone:843-970-3200
Mailing Address - Fax:843-353-2406
Practice Address - Street 1:5502 MEMORIAL BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477-2286
Practice Address - Country:US
Practice Address - Phone:843-970-3200
Practice Address - Fax:843-353-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty