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General NPI Number Information
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NPI Number | 1568730380
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE NORTHEAST COLUMBIA, INC.
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 715 FASHION DR SUITE 3
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City | COLUMBIA
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State | SC
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Zip | 29229-4224
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Country | US
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Telephone | 803-260-7990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1771
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City | COLUMBIA
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State | SC
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Zip | 29202-1771
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Country | US
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Telephone | 803-260-7990
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH CAREW
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Credential | D.C.
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Telephone | 803-260-7990
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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 | 2006
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License Number State | SC
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