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General NPI Number Information
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NPI Number | 1013953934
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Entity Type | Organization
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Legal Business Name | CHARLESTON NECK & BACK CENTER PA
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 03/11/2015
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Provider Practice Location Address
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Address Line | 1835 SAVAGE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4726
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Country | US
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Telephone | 843-763-2225
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Fax | 843-763-3433
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Provider Business Mailing Address
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Address Line | 1835 SAVAGE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4726
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Country | US
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Telephone | 843-763-2225
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Fax | 843-763-3433
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH D ROLES
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Credential | D.C.
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Telephone | 843-266-2650
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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 | 1087
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License Number State | SC
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