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General NPI Number Information
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NPI Number | 1326306424
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Entity Type | Organization
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Legal Business Name | JAMES ISLAND FAMILY CHIROPRACTIC, LLC.
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 04/26/2012
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Provider Practice Location Address
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Address Line | 1939 MAYBANK HWY
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City | CHARLESTON
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State | SC
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Zip | 29412-2114
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Country | US
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Telephone | 843-795-1999
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Fax | 843-795-1981
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Provider Business Mailing Address
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Address Line | 1939 MAYBANK HWY
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City | CHARLESTON
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State | SC
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Zip | 29412-2114
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Country | US
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Telephone | 843-795-1999
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Fax | 843-795-1981
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATT MICHAUD
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Credential | D.C.
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Telephone | 843-795-1999
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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 | 3676
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License Number State | SC
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