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General NPI Number Information
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NPI Number | 1114572518
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Entity Type | Organization
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Legal Business Name | CAROLINA SPINE AND SPORT
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Dates
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Enumeration Date | 08/03/2019
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Last Update Date | 08/03/2019
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Provider Practice Location Address
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Address Line | 946 ORLEANS RD UNIT B10
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City | CHARLESTON
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State | SC
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Zip | 29407-4839
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Country | US
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Telephone | 918-728-0201
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Fax |
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Provider Business Mailing Address
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Address Line | 1871 ASHLEY RIVER RD APT 4311
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City | CHARLESTON
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State | SC
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Zip | 29407-8724
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Country | US
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Telephone | 918-728-0201
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. DEV'N MORAN
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Credential | DC
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Telephone | 918-728-0201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number |
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License Number State |
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