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General NPI Number Information
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NPI Number | 1588073233
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN CHIROPRACTIC CENTER P C
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 6420 GARNERS FERRY RD
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City | COLUMBIA
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State | SC
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Zip | 29209-1632
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Country | US
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Telephone | 803-553-3368
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11596
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City | COLUMBIA
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State | SC
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Zip | 29211-1596
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Country | US
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Telephone | 803-553-3368
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEWIS RANDAL HINSON
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Credential | DC, CCSP
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Telephone | 803-553-3368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1581
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License Number State | SC
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