Provider Demographics
NPI:1932316130
Name:ALPHA MEDICAL & SPINAL CARE, LLC
Entity Type:Organization
Organization Name:ALPHA MEDICAL & SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-795-3056
Mailing Address - Street 1:PO BOX 12999
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-2999
Mailing Address - Country:US
Mailing Address - Phone:843-556-7828
Mailing Address - Fax:843-556-8652
Practice Address - Street 1:435 FOLLY RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2624
Practice Address - Country:US
Practice Address - Phone:843-795-3056
Practice Address - Fax:843-762-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT251686987Medicare UPIN