Healthcare Provider Details

I. General information

NPI: 1568560159
Provider Name (Legal Business Name): KEYSTONE CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SAVANNAH HWY
CHARLESTON SC
29407-7802
US

IV. Provider business mailing address

912 SAVANNAH HWY
CHARLESTON SC
29407-7802
US

V. Phone/Fax

Practice location:
  • Phone: 843-225-4080
  • Fax: 843-225-5210
Mailing address:
  • Phone: 843-225-4080
  • Fax: 843-225-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberSC2639
License Number StateSC

VIII. Authorized Official

Name: DR. ALEXANDER COOKER
Title or Position: DOCTOR/PRESIDENT
Credential: D.C.
Phone: 843-225-4080