Provider Demographics
NPI:1558535666
Name:COLE CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:COLE CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-416-8593
Mailing Address - Street 1:636 LONG POINT RD
Mailing Address - Street 2:UNIT G #101
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8286
Mailing Address - Country:US
Mailing Address - Phone:843-416-8593
Mailing Address - Fax:855-738-7785
Practice Address - Street 1:3404 SALTERBECK ST
Practice Address - Street 2:# 201
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7119
Practice Address - Country:US
Practice Address - Phone:843-416-8593
Practice Address - Fax:855-738-7785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3204111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8991Medicare PIN