Healthcare Provider Details

I. General information

NPI: 1578454070
Provider Name (Legal Business Name): IJEBUSOMMA OKOYE DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2025
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 OLD TROLLEY RD
SUMMERVILLE SC
29485-5668
US

IV. Provider business mailing address

613 OLD TROLLEY RD
SUMMERVILLE SC
29485-5668
US

V. Phone/Fax

Practice location:
  • Phone: 843-708-6683
  • Fax:
Mailing address:
  • Phone: 843-708-6683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5170
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: