Provider Demographics
NPI:1629627757
Name:PROGRESSIVE CHIROPRACTIC & ORTHOPEDIC
Entity Type:Organization
Organization Name:PROGRESSIVE CHIROPRACTIC & ORTHOPEDIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-509-1855
Mailing Address - Street 1:7921 BROAD RIVER RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2358
Mailing Address - Country:US
Mailing Address - Phone:803-509-1855
Mailing Address - Fax:
Practice Address - Street 1:7921 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2358
Practice Address - Country:US
Practice Address - Phone:803-509-1855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty