Healthcare Provider Details

I. General information

NPI: 1760560601
Provider Name (Legal Business Name): MT PLEASANT FAMILY HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 PARK WEST BLVD STE D
MT PLEASANT SC
29466-7120
US

IV. Provider business mailing address

1117 PARK WEST BLVD STE D
MT PLEASANT SC
29466-7120
US

V. Phone/Fax

Practice location:
  • Phone: 843-884-6194
  • Fax: 480-393-4132
Mailing address:
  • Phone: 843-884-6194
  • Fax: 480-393-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1830
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15987
License Number StateSC

VIII. Authorized Official

Name: MR. JOSEPH PATRICK MARKOVICH
Title or Position: DIRECTOR
Credential: DC
Phone: 843-884-6194