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General NPI Number Information
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NPI Number | 1306356845
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Entity Type | Organization
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Legal Business Name | FOUNDATION FAMILY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 10/11/2017
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 455 OLD TROLLEY RD STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5669
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Country | US
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Telephone | 843-851-2417
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Fax |
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Provider Business Mailing Address
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Address Line | 455 OLD TROLLEY RD STE A
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City | SUMMERVILLE
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State | SC
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Zip | 29485-5669
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Country | US
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Telephone | 843-851-2417
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE HEIMER
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Credential |
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Telephone | 815-955-0406
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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 | 4089
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License Number State | SC
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