Provider Demographics
NPI:1508941253
Name:DREW FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:DREW FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DREW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-865-3000
Mailing Address - Street 1:26 OFFICE PARK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-5954
Mailing Address - Country:US
Mailing Address - Phone:803-865-3000
Mailing Address - Fax:803-865-5444
Practice Address - Street 1:26 OFFICE PARK CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-5954
Practice Address - Country:US
Practice Address - Phone:803-865-3000
Practice Address - Fax:803-865-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3005111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3005Medicaid
SC8602Medicare PIN
SCV048058602Medicare UPIN