Provider Demographics
NPI:1568653434
Name:CHIROPRACTIC CARE CENTER P.A.
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:JONES-MCCAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-781-8866
Mailing Address - Street 1:7245 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1178
Mailing Address - Country:US
Mailing Address - Phone:803-781-8866
Mailing Address - Fax:803-781-8868
Practice Address - Street 1:7245 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1178
Practice Address - Country:US
Practice Address - Phone:803-781-8866
Practice Address - Fax:803-781-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2165111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2157Medicare PIN