Provider Demographics
NPI:1790942126
Name:ABSOLUTE CHIROPRACTIC
Entity Type:Organization
Organization Name:ABSOLUTE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-824-1777
Mailing Address - Street 1:PO BOX 2137
Mailing Address - Street 2:SUITE D
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2137
Mailing Address - Country:US
Mailing Address - Phone:843-824-1777
Mailing Address - Fax:843-824-1779
Practice Address - Street 1:514 ST JAMES AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2767
Practice Address - Country:US
Practice Address - Phone:843-824-1777
Practice Address - Fax:843-824-1779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH2544Medicaid
SC8196Medicare PIN
SCCH2544Medicaid