Provider Demographics
NPI:1689755480
Name:FLEX CHIROPRACTIC OF LEXINGTON
Entity Type:Organization
Organization Name:FLEX CHIROPRACTIC OF LEXINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:BUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-861-4737
Mailing Address - Street 1:305 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2613
Mailing Address - Country:US
Mailing Address - Phone:803-520-4615
Mailing Address - Fax:803-520-4617
Practice Address - Street 1:305 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2613
Practice Address - Country:US
Practice Address - Phone:803-520-4615
Practice Address - Fax:803-520-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH511Medicaid
SCGCH511Medicaid