Provider Demographics
NPI:1669630828
Name:CHIROPRACTIC FAMILY PHYSICIANS PA
Entity Type:Organization
Organization Name:CHIROPRACTIC FAMILY PHYSICIANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:BOCCHINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-855-1515
Mailing Address - Street 1:729 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3153
Mailing Address - Country:US
Mailing Address - Phone:864-855-1515
Mailing Address - Fax:864-855-0488
Practice Address - Street 1:729 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3153
Practice Address - Country:US
Practice Address - Phone:864-855-1515
Practice Address - Fax:864-855-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH547Medicaid
SC8814Medicare PIN
SCU88431Medicare UPIN