Provider Demographics
NPI:1700962123
Name:CAROLINA CHIROPRACTIC
Entity Type:Organization
Organization Name:CAROLINA CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:HEWETSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:803-328-2800
Mailing Address - Street 1:1120 EBENEZER AVE. EXT.
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3023
Mailing Address - Country:US
Mailing Address - Phone:803-328-2800
Mailing Address - Fax:803-328-0110
Practice Address - Street 1:1120 EBENEZER AVE. EXT.
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3023
Practice Address - Country:US
Practice Address - Phone:803-328-2800
Practice Address - Fax:803-328-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC978111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT25015Medicare UPIN
SC4179Medicare ID - Type Unspecified