Provider Demographics
NPI:1740827773
Name:CHARLESTON CHIROPRACTIC STUDIO, LLC
Entity type:Organization
Organization Name:CHARLESTON CHIROPRACTIC STUDIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KASANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUETTIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-852-4141
Mailing Address - Street 1:1941 SAVAGE RD STE 300D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-4790
Mailing Address - Country:US
Mailing Address - Phone:843-852-4141
Mailing Address - Fax:843-793-2952
Practice Address - Street 1:1941 SAVAGE RD STE 300D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4790
Practice Address - Country:US
Practice Address - Phone:843-852-4141
Practice Address - Fax:843-793-2952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty