Provider Demographics
NPI:1013954551
Name:PALMETTO WELLNESS & INJURY CENTER INC.
Entity Type:Organization
Organization Name:PALMETTO WELLNESS & INJURY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:843-665-7110
Mailing Address - Street 1:PO BOX 5282
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-5282
Mailing Address - Country:US
Mailing Address - Phone:843-665-7110
Mailing Address - Fax:843-665-1282
Practice Address - Street 1:436 W PALMETTO ST.
Practice Address - Street 2:SUITE B
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501
Practice Address - Country:US
Practice Address - Phone:843-665-7110
Practice Address - Fax:843-665-1282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PALMETTO WELLNESS & INJURY CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-01
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCH1729Medicaid
SCU43323Medicare UPIN
6274Medicare PIN
SC6274Medicare PIN
SC6272Medicare PIN
SC6272&6274Medicare UPIN