Healthcare Provider Details

I. General information

NPI: 1326577826
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL FAGERSTROM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2070 NORTHBROOK BLVD STE B5
NORTH CHARLESTON SC
29406-9254
US

IV. Provider business mailing address

2070 NORTHBROOK BLVD STE B5
NORTH CHARLESTON SC
29406-9254
US

V. Phone/Fax

Practice location:
  • Phone: 843-641-7075
  • Fax:
Mailing address:
  • Phone: 843-641-7075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4213
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: