Provider Demographics
NPI:1639268014
Name:GWINNUP, BRUCE H (DC)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:H
Last Name:GWINNUP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 FOLLY RD
Mailing Address - Street 2:SUITE1
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2594
Mailing Address - Country:US
Mailing Address - Phone:843-795-9333
Mailing Address - Fax:843-762-3892
Practice Address - Street 1:354 FOLLY RD
Practice Address - Street 2:SUITE1
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2594
Practice Address - Country:US
Practice Address - Phone:843-795-9333
Practice Address - Fax:843-762-3892
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor