Provider Demographics
NPI:1407569049
Name:COLUMBIA FAMILY CHIROPRACTIC NORTHEAST LLC
Entity Type:Organization
Organization Name:COLUMBIA FAMILY CHIROPRACTIC NORTHEAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STETSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-995-9193
Mailing Address - Street 1:124 N BRICKYARD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6902
Mailing Address - Country:US
Mailing Address - Phone:803-788-8831
Mailing Address - Fax:
Practice Address - Street 1:124 N BRICKYARD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6902
Practice Address - Country:US
Practice Address - Phone:800-788-8831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-28
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty