Provider Demographics
NPI:1619040490
Name:ACCIDENT INJURY CHIRO
Entity Type:Organization
Organization Name:ACCIDENT INJURY CHIRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WAPNER CH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-496-3338
Mailing Address - Street 1:PO BOX 1487
Mailing Address - Street 2:
Mailing Address - City:HOLLY HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29059-1487
Mailing Address - Country:US
Mailing Address - Phone:803-496-3338
Mailing Address - Fax:
Practice Address - Street 1:1120 STATE ST
Practice Address - Street 2:
Practice Address - City:HOLLY HILL
Practice Address - State:SC
Practice Address - Zip Code:29059-2611
Practice Address - Country:US
Practice Address - Phone:803-496-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC803111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH182Medicaid
SCGCH182Medicaid