Healthcare Provider Details

I. General information

NPI: 1730258823
Provider Name (Legal Business Name): GEORGETOWN CHIROPRACTIC & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 NORTH FRASER STREET SUITE A
GEORGETOWN SC
29440
US

IV. Provider business mailing address

722 NORTH FRASER STREET SUITE A
GEORGETOWN SC
29440
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-4200
  • Fax: 843-527-4222
Mailing address:
  • Phone: 843-527-4200
  • Fax: 843-527-4222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2644
License Number StateSC

VIII. Authorized Official

Name: KEVIN A MORRIS
Title or Position: OWNER
Credential: DC
Phone: 843-527-4200