Provider Demographics
NPI:1467604330
Name:CHIROPRACTIC PROFESSIONALS
Entity Type:Organization
Organization Name:CHIROPRACTIC PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRYANT-BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-315-6159
Mailing Address - Street 1:2319 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8043
Mailing Address - Country:US
Mailing Address - Phone:585-315-6159
Mailing Address - Fax:
Practice Address - Street 1:2319 N LAKE DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-8043
Practice Address - Country:US
Practice Address - Phone:585-315-6159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3390111N00000X
SC3384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty