Provider Demographics
NPI:1750302733
Name:ADVANCED CHIROPRACTIC OF AIKEN LLC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF AIKEN LLC
Other - Org Name:ADVANCED CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-648-0172
Mailing Address - Street 1:1028 RICHLAND AVE E
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-4760
Mailing Address - Country:US
Mailing Address - Phone:803-648-0172
Mailing Address - Fax:803-648-5062
Practice Address - Street 1:1028 RICHLAND AVE E
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-4760
Practice Address - Country:US
Practice Address - Phone:803-648-0172
Practice Address - Fax:803-648-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2563Medicaid