Healthcare Provider Details

I. General information

NPI: 1962726117
Provider Name (Legal Business Name): WEST ASHLEY WELLNESS & REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 02/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CARRIAGE LN
CHARLESTON SC
29407-6010
US

IV. Provider business mailing address

2 CARRIAGE LN
CHARLESTON SC
29407-6010
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-3100
  • Fax: 843-766-7798
Mailing address:
  • Phone: 843-571-3100
  • Fax: 843-766-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number2265
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number23765
License Number StateSC

VIII. Authorized Official

Name: KAREN R LUCKIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-571-3100