Provider Demographics
NPI:1639485071
Name:MY CHIROPRACTOR LLC
Entity Type:Organization
Organization Name:MY CHIROPRACTOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-574-8881
Mailing Address - Street 1:1454 GENTRY MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-6940
Mailing Address - Country:US
Mailing Address - Phone:864-644-2700
Mailing Address - Fax:864-644-2709
Practice Address - Street 1:16 WILLIAM POPE DR
Practice Address - Street 2:STE 103
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-7502
Practice Address - Country:US
Practice Address - Phone:843-505-6099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2015-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3285OtherDC LICENSE