Provider Demographics
NPI:1891059200
Name:HOLISTIC CARE OF CHARLESTON
Entity Type:Organization
Organization Name:HOLISTIC CARE OF CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GWINNUP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-795-9333
Mailing Address - Street 1:354 FOLLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2594
Mailing Address - Country:US
Mailing Address - Phone:843-795-9333
Mailing Address - Fax:866-610-1495
Practice Address - Street 1:354 FOLLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2594
Practice Address - Country:US
Practice Address - Phone:843-795-9333
Practice Address - Fax:866-610-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2144111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU675310281OtherMEDICARE PTAN