Healthcare Provider Details

I. General information

NPI: 1598035958
Provider Name (Legal Business Name): CAROLINA WELLNESS AND HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 PINE LOG RD SUITE B
AIKEN SC
29803-7890
US

IV. Provider business mailing address

1310 PINE LOG RD SUITE B
AIKEN SC
29803-7890
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0217
  • Fax: 803-226-0459
Mailing address:
  • Phone: 803-226-0217
  • Fax: 803-226-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3663
License Number StateSC

VIII. Authorized Official

Name: DR. PHILIP RUSSELL JORDAN
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 803-226-0217