Provider Demographics
NPI:1780650747
Name:LIMA, BRIAN P (DC)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:LIMA
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:PO BOX 60609
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0609
Mailing Address - Country:US
Mailing Address - Phone:843-764-1995
Mailing Address - Fax:843-764-4926
Practice Address - Street 1:7565 RIVERS AVE
Practice Address - Street 2:SUITE C
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4633
Practice Address - Country:US
Practice Address - Phone:843-764-1995
Practice Address - Fax:843-764-4926
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2206111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH352Medicaid
SCU715500281Medicare UPIN
SCGCH352Medicaid