Healthcare Provider Details

I. General information

NPI: 1770721615
Provider Name (Legal Business Name): JEFFREY P. KRAICHELY, D.C., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 CENTRAL AVE
SUMMERVILLE SC
29483-3148
US

IV. Provider business mailing address

713 CENTRAL AVE
SUMMERVILLE SC
29483-3713
US

V. Phone/Fax

Practice location:
  • Phone: 843-821-8787
  • Fax: 843-821-8799
Mailing address:
  • Phone: 843-513-6674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number006573
License Number StateMO

VIII. Authorized Official

Name: DR. JEFFREY PATRICK KRAICHELY
Title or Position: PRESIDENT
Credential: DC
Phone: 843-821-8787