Provider Demographics
NPI:1790877819
Name:LOW COUNTRY SPINE CENTER PC
Entity Type:Organization
Organization Name:LOW COUNTRY SPINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:LEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-216-0200
Mailing Address - Street 1:1000 JOHNNIE DODDS BLVD
Mailing Address - Street 2:SUITE 105-B
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3135
Mailing Address - Country:US
Mailing Address - Phone:843-216-0200
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE 105-B
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3135
Practice Address - Country:US
Practice Address - Phone:843-216-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2479111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty