Provider Demographics
NPI:1003499096
Name:ARENTSEN FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ARENTSEN FAMILY CHIROPRACTIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BREANN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ARENTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-419-6955
Mailing Address - Street 1:1907 VARNER ST STE C2
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8104
Mailing Address - Country:US
Mailing Address - Phone:843-419-6955
Mailing Address - Fax:
Practice Address - Street 1:1907 VARNER ST STE C2
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8104
Practice Address - Country:US
Practice Address - Phone:414-839-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124551064OtherNPI