Provider Demographics
NPI:1598753626
Name:BLACK, CHRISTOPHER MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:BLACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 S HERLONG AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9446
Mailing Address - Country:US
Mailing Address - Phone:803-328-3444
Mailing Address - Fax:803-328-6811
Practice Address - Street 1:430 S HERLONG AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9446
Practice Address - Country:US
Practice Address - Phone:803-328-3444
Practice Address - Fax:803-328-6811
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2607111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2607Medicaid
SCCH2607Medicaid
SC86573Medicare UPIN