Provider Demographics
NPI:1417088840
Name:ARNSDORFF, MARVIN T (DC)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:T
Last Name:ARNSDORFF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 ANNA KNAPP BOULEVARD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3134
Mailing Address - Country:US
Mailing Address - Phone:843-881-0046
Mailing Address - Fax:843-881-0098
Practice Address - Street 1:1004 ANNA KNAPP BOULEVARD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3134
Practice Address - Country:US
Practice Address - Phone:843-881-0046
Practice Address - Fax:843-881-0098
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1089111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH156Medicaid
SC570842962OtherTAX ID NUMBER
SCT248870281Medicare ID - Type UnspecifiedMEDICARE ID NUMBER