Provider Demographics
NPI:1013903970
Name:CHARLESTON NON SURGICAL CENTER
Entity Type:Organization
Organization Name:CHARLESTON NON SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:AZZOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-769-4188
Mailing Address - Street 1:2352 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-4752
Mailing Address - Country:US
Mailing Address - Phone:843-769-4188
Mailing Address - Fax:843-769-4199
Practice Address - Street 1:2352 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-4752
Practice Address - Country:US
Practice Address - Phone:843-769-4188
Practice Address - Fax:843-769-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1146111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T23620Medicare UPIN
SC8017Medicare PIN