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General NPI Number Information
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NPI Number | 1013322684
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Entity Type | Organization
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Legal Business Name | RESTORE CHIROPRACTIC FAMILY WELLNESS CENTER
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Dates
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Enumeration Date | 06/23/2014
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 9016 FARROW RD STE B
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City | COLUMBIA
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State | SC
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Zip | 29203-8933
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Country | US
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Telephone | 803-699-8171
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Fax |
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Provider Business Mailing Address
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Address Line | 9016 FARROW RD STE B
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City | COLUMBIA
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State | SC
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Zip | 29203-8933
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. MARTIA CREIGHTON THIGPEN
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Credential | D.C.
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Telephone | 803-699-8171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3250
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License Number State | SC
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