Provider Demographics
NPI:1790190049
Name:OLD MILL CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:OLD MILL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARENKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-808-0711
Mailing Address - Street 1:711 E MAIN ST STE L2
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-3670
Mailing Address - Country:US
Mailing Address - Phone:803-808-0711
Mailing Address - Fax:803-808-0713
Practice Address - Street 1:711 E MAIN ST STE L2
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-3670
Practice Address - Country:US
Practice Address - Phone:803-808-0711
Practice Address - Fax:803-808-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3572111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1841518735OtherPERSONAL NPI