Provider Demographics
NPI:1972801447
Name:BONE, CHAD WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:WILLIAM
Last Name:BONE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 HIGHWAY 17 S
Mailing Address - Street 2:UNIT E
Mailing Address - City:SURFSIDE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29575-6091
Mailing Address - Country:US
Mailing Address - Phone:843-945-4087
Mailing Address - Fax:843-945-4091
Practice Address - Street 1:640 HIGHWAY 17 S
Practice Address - Street 2:UNIT E
Practice Address - City:SURFSIDE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29575-6091
Practice Address - Country:US
Practice Address - Phone:843-945-4087
Practice Address - Fax:843-945-4091
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH3566Medicaid
SCCH3566Medicaid