Provider Demographics
NPI:1336387034
Name:PALMETTO CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:PALMETTO CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-873-0081
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29484-0097
Mailing Address - Country:US
Mailing Address - Phone:843-873-0081
Mailing Address - Fax:843-821-4310
Practice Address - Street 1:300 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6433
Practice Address - Country:US
Practice Address - Phone:843-873-0081
Practice Address - Fax:843-821-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-03
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU493440282Medicare UPIN