Provider Demographics
NPI:1508938770
Name:PALMETTO CHIROPRACTIC NECK AND BACK CENTER OF THE PEE DEE, LLC
Entity Type:Organization
Organization Name:PALMETTO CHIROPRACTIC NECK AND BACK CENTER OF THE PEE DEE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WENNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-662-8000
Mailing Address - Street 1:2147 HOFFMEYER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4015
Mailing Address - Country:US
Mailing Address - Phone:843-662-8000
Mailing Address - Fax:843-664-0994
Practice Address - Street 1:2147 HOFFMEYER RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4015
Practice Address - Country:US
Practice Address - Phone:843-662-8000
Practice Address - Fax:843-664-0994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2843111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1639162605OtherDR. BRYAN WENNER
SCCH2843Medicaid
SCU97485Medicare UPIN
SCAA01657780Medicare ID - Type UnspecifiedMEDICARE ID