Provider Demographics
NPI:1609829134
Name:GEORGETOWN CHIROPRACTIC & WELLNESS CENTER
Entity Type:Organization
Organization Name:GEORGETOWN CHIROPRACTIC & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-527-4200
Mailing Address - Street 1:722 NORTH FRASER STREET
Mailing Address - Street 2:STE A
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29440
Mailing Address - Country:US
Mailing Address - Phone:843-527-4200
Mailing Address - Fax:843-527-4222
Practice Address - Street 1:722 NORTH FRASER STREET
Practice Address - Street 2:STE A
Practice Address - City:GEORGETOWN
Practice Address - State:SC
Practice Address - Zip Code:29440
Practice Address - Country:US
Practice Address - Phone:843-527-4200
Practice Address - Fax:843-527-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH513Medicaid
SCGCH513Medicaid