Provider Demographics
NPI:1578313094
Name:MODERN CHIROPRACTIC HEALTH CENTER INC
Entity Type:Organization
Organization Name:MODERN CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALORI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTIMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-998-7534
Mailing Address - Street 1:512 HAYES PARK BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-4962
Mailing Address - Country:US
Mailing Address - Phone:843-998-7534
Mailing Address - Fax:843-376-9429
Practice Address - Street 1:512 HAYES PARK BLVD STE 102
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-4962
Practice Address - Country:US
Practice Address - Phone:843-998-7534
Practice Address - Fax:843-376-9429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty