Provider Demographics
NPI:1750442695
Name:CAYCE CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CAYCE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-796-2424
Mailing Address - Street 1:PO BOX 3005
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-3005
Mailing Address - Country:US
Mailing Address - Phone:803-796-2424
Mailing Address - Fax:803-791-4076
Practice Address - Street 1:1106 12TH ST
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3305
Practice Address - Country:US
Practice Address - Phone:803-796-2424
Practice Address - Fax:803-796-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2248111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC8885Medicare PIN
SC8176Medicare PIN