Healthcare Provider Details

I. General information

NPI: 1831961457
Provider Name (Legal Business Name): VARVARA KONONOV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WESTEDGE ST STE 103
CHARLESTON SC
29403-6983
US

IV. Provider business mailing address

539 BRICK BARN LN
GOOSE CREEK SC
29445-7342
US

V. Phone/Fax

Practice location:
  • Phone: 843-628-3319
  • Fax: 843-628-3319
Mailing address:
  • Phone: 843-801-5375
  • Fax: 843-628-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4944
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: