Provider Demographics
NPI:1629244330
Name:MAHAN CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:MAHAN CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:MAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-427-6410
Mailing Address - Street 1:214 S MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-2331
Mailing Address - Country:US
Mailing Address - Phone:864-427-6410
Mailing Address - Fax:864-427-0144
Practice Address - Street 1:214 S MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-2331
Practice Address - Country:US
Practice Address - Phone:864-427-6410
Practice Address - Fax:864-427-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH0687Medicaid
SCT245558981Medicare PIN
SCCH0687Medicaid