Provider Demographics
NPI:1841605821
Name:AIKEN CHIROPRACTIC WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:AIKEN CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:AIKEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:352-347-3404
Mailing Address - Street 1:15580 S US HIGHWAY 441
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-4426
Mailing Address - Country:US
Mailing Address - Phone:352-347-3404
Mailing Address - Fax:352-347-3350
Practice Address - Street 1:15580 S US HIGHWAY 441
Practice Address - Street 2:SUITE 1
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-4426
Practice Address - Country:US
Practice Address - Phone:352-347-3404
Practice Address - Fax:352-347-3350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-27
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1377111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL89003Medicare PIN