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General NPI Number Information
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NPI Number | 1508443060
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Entity Type | Organization
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Legal Business Name | DYNAMIC CHIROPRACTIC AND FUNCTIONAL MOVEMENT LLC
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Dates
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Enumeration Date | 03/29/2021
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 1314 LINCOLN ST STE 218
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City | COLUMBIA
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State | SC
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Zip | 29201-3154
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Country | US
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Telephone | 803-574-9344
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 LINCOLN ST STE 218
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City | COLUMBIA
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State | SC
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Zip | 29201-3154
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Country | US
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Telephone | 803-574-9344
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | KATELYN SEABA
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Credential | DC
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Telephone | 319-331-2006
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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 |
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License Number State |
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