Provider Demographics
NPI:1922059161
Name:DALE FRIAR
Entity Type:Organization
Organization Name:DALE FRIAR
Other - Org Name:SWEETGRASS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-971-0540
Mailing Address - Street 1:1909 HIGHWAY 17 BYP N
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7459
Mailing Address - Country:US
Mailing Address - Phone:843-971-0540
Mailing Address - Fax:843-971-0340
Practice Address - Street 1:1909 HIGHWAY 17 BYP N
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-7459
Practice Address - Country:US
Practice Address - Phone:843-971-0540
Practice Address - Fax:843-971-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1731Medicaid
SCCH1731Medicaid
SCT328850281Medicare PIN
SCCH1731Medicaid
SC0285Medicare PIN