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General NPI Number Information
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NPI Number | 1104804061
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Entity Type | Organization
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Legal Business Name | TOTAL LIFE CARE CHARLESTON, LLC
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Dates
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Enumeration Date | 01/02/2006
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 825 WAPPOO RD
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City | CHARLESTON
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State | SC
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Zip | 29407-5866
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Country | US
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Telephone | 843-402-0310
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Fax | 843-402-9819
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Provider Business Mailing Address
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Address Line | 825 WAPPOO RD
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City | CHARLESTON
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State | SC
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Zip | 29407-5866
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Country | US
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Telephone | 843-402-0310
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Fax | 843-402-9819
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. HENRY WALTER LATTER JR.
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Credential | D.C.
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Telephone | 843-402-0310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 3054
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License Number State | SC
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