Provider Demographics
NPI:1669624128
Name:CHARLESTON CHIROPRACTIC AND THERAPY, LLC
Entity type:Organization
Organization Name:CHARLESTON CHIROPRACTIC AND THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-722-7074
Mailing Address - Street 1:360 CONCORD ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-6353
Mailing Address - Country:US
Mailing Address - Phone:843-722-7074
Mailing Address - Fax:843-722-9749
Practice Address - Street 1:360 CONCORD ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-6353
Practice Address - Country:US
Practice Address - Phone:843-722-7074
Practice Address - Fax:843-722-9749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2677111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty