Provider Demographics
NPI:1639250186
Name:LAKE MURRAY CHIROPRACTIC
Entity Type:Organization
Organization Name:LAKE MURRAY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BULL
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:803-345-0334
Mailing Address - Street 1:510 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9424
Mailing Address - Country:US
Mailing Address - Phone:803-345-0334
Mailing Address - Fax:803-345-5462
Practice Address - Street 1:510 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9424
Practice Address - Country:US
Practice Address - Phone:803-345-0334
Practice Address - Fax:803-345-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2186111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty