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General NPI Number Information
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NPI Number | 1104045053
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Entity Type | Organization
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Legal Business Name | MCKOOL LIFETIME CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1954 ASHLEY RIVER RD STE D
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City | CHARLESTON
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State | SC
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Zip | 29407-4904
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Country | US
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Telephone | 843-571-6440
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Fax | 843-571-6448
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Provider Business Mailing Address
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Address Line | 1954 ASHLEY RIVER RD STE D
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City | CHARLESTON
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State | SC
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Zip | 29407-4904
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Country | US
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Telephone | 843-571-6440
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Fax | 843-571-6448
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Authorized Official
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Title or Position | OWNER
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Name | DR. JACQUELINE ANN MCKOOL
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Credential | D.C.
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Telephone | 843-571-6440
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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 | 2713
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License Number State | SC
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