Provider Demographics
NPI:1356337216
Name:BORGSTADT, KY ALLEN (DC)
Entity type:Individual
Prefix:DR
First Name:KY
Middle Name:ALLEN
Last Name:BORGSTADT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 HARD SCRABBLE RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-9453
Mailing Address - Country:US
Mailing Address - Phone:803-462-6110
Mailing Address - Fax:803-462-9814
Practice Address - Street 1:4611 HARD SCRABBLE RD
Practice Address - Street 2:SUITE 115
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-9453
Practice Address - Country:US
Practice Address - Phone:803-462-6110
Practice Address - Fax:803-462-9814
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor