Healthcare Provider Details

I. General information

NPI: 1396346458
Provider Name (Legal Business Name): PALMETTO ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 SUMTER ST
COLUMBIA SC
29201-2501
US

IV. Provider business mailing address

1825 SUMTER ST
COLUMBIA SC
29201-2501
US

V. Phone/Fax

Practice location:
  • Phone: 803-806-8889
  • Fax:
Mailing address:
  • Phone: 803-806-8889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MARTIN HERBKERSMAN
Title or Position: OWNER/ CHIEF ACUPUNCTURIST
Credential: LAC
Phone: 803-806-8889