Healthcare Provider Details

I. General information

NPI: 1619040490
Provider Name (Legal Business Name): ACCIDENT INJURY CHIRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 STATE ST
HOLLY HILL SC
29059-2611
US

IV. Provider business mailing address

PO BOX 1487
HOLLY HILL SC
29059-1487
US

V. Phone/Fax

Practice location:
  • Phone: 803-496-3338
  • Fax:
Mailing address:
  • Phone: 803-496-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number803
License Number StateSC

VIII. Authorized Official

Name: CHARLES WAPNER CH
Title or Position: PRESIDENT
Credential:
Phone: 803-496-3338