Provider Demographics
NPI:1558738344
Name:CAROLINA INTEGRATED MEDICINE LLC
Entity Type:Organization
Organization Name:CAROLINA INTEGRATED MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-233-9387
Mailing Address - Street 1:8451 CHARLOTTE HWY
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7587
Mailing Address - Country:US
Mailing Address - Phone:803-548-8114
Mailing Address - Fax:
Practice Address - Street 1:8451 CHARLOTTE HWY
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7587
Practice Address - Country:US
Practice Address - Phone:803-548-8114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37092081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty