Healthcare Provider Details

I. General information

NPI: 1104438316
Provider Name (Legal Business Name): PASAMB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 CHESTERFIELD ST S
AIKEN SC
29801-7113
US

IV. Provider business mailing address

227 CHESTERFIELD ST S
AIKEN SC
29801-7113
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-0231
  • Fax:
Mailing address:
  • Phone: 803-226-0231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. EKECHI NWOGA
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 646-415-0304