Provider Demographics
NPI:1689668097
Name:CUNNINGHAM, CHANNING PRESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:CHANNING
Middle Name:PRESLEY
Last Name:CUNNINGHAM
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 1:313 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4123
Mailing Address - Country:US
Mailing Address - Phone:803-938-8308
Mailing Address - Fax:803-938-8191
Practice Address - Street 1:313 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4123
Practice Address - Country:US
Practice Address - Phone:803-938-8308
Practice Address - Fax:803-938-8191
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICC008854111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIV03408Medicare UPIN
MI0P13220Medicare ID - Type Unspecified