Provider Demographics
NPI:1679716971
Name:LLOP, RAFAEL (DC)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:LLOP
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 1:320 W COLEMAN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3449
Mailing Address - Country:US
Mailing Address - Phone:843-881-6343
Mailing Address - Fax:843-278-8449
Practice Address - Street 1:320 W COLEMAN BLVD STE E
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3449
Practice Address - Country:US
Practice Address - Phone:843-881-6343
Practice Address - Fax:843-278-8449
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-16
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3432111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3432Medicaid
SCAA44210281Medicare PIN