Provider Demographics
NPI:1932794906
Name:EAST COAST FUNCTIONAL MEDICINE LLC
Entity Type:Organization
Organization Name:EAST COAST FUNCTIONAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-873-0081
Mailing Address - Street 1:300 N CEDAR ST STE E
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6433
Mailing Address - Country:US
Mailing Address - Phone:843-873-0081
Mailing Address - Fax:843-821-4310
Practice Address - Street 1:300 N CEDAR ST STE E
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6433
Practice Address - Country:US
Practice Address - Phone:843-873-0081
Practice Address - Fax:843-821-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty