Provider Demographics
NPI:1770721615
Name:JEFFREY P. KRAICHELY, D.C., P.C.
Entity type:Organization
Organization Name:JEFFREY P. KRAICHELY, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KRAICHELY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-821-8787
Mailing Address - Street 1:713 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3713
Mailing Address - Country:US
Mailing Address - Phone:843-513-6674
Mailing Address - Fax:
Practice Address - Street 1:1240 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3148
Practice Address - Country:US
Practice Address - Phone:843-821-8787
Practice Address - Fax:843-821-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006573111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty