=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043411465
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL G REGAN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2007
-----------------------------------------------------
Last Update Date | 04/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 CENTRAL AVE SUITE 300 B
-----------------------------------------------------
City | GOOSE CREEK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29445-3084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-569-1212
-----------------------------------------------------
Fax | 843-569-1909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105 CENTRAL AVE SUITE300 B
-----------------------------------------------------
City | GOOSE CREEK
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29445-3084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-569-1212
-----------------------------------------------------
Fax | 843-569-1909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL GERARD REGAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 843-569-1212
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1171
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------