Provider Demographics
NPI:1184806291
Name:GITTENS CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:GITTENS CHIROPRACTIC CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:GITTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-678-9394
Mailing Address - Street 1:333 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4417
Mailing Address - Country:US
Mailing Address - Phone:843-678-9394
Mailing Address - Fax:843-678-9909
Practice Address - Street 1:333 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4417
Practice Address - Country:US
Practice Address - Phone:843-678-9394
Practice Address - Fax:843-678-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGCH206Medicaid