Healthcare Provider Details

I. General information

NPI: 1366711244
Provider Name (Legal Business Name): GREATER CAROLINA CLINIC OF CHIROPRACTIC, INC..
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 02/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WILDEWOOD PARK DR STE B
COLUMBIA SC
29223-4319
US

IV. Provider business mailing address

101 WILDEWOOD PARK DR., SUITE B
COLUMBIA SC
29223
US

V. Phone/Fax

Practice location:
  • Phone: 803-788-7890
  • Fax: 803-250-2581
Mailing address:
  • Phone: 803-788-7890
  • Fax: 803-250-2581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3399
License Number StateSC

VIII. Authorized Official

Name: DR. PATRICIA PLATTS BRICKEY
Title or Position: OWNER
Credential: D.C.
Phone: 803788789080