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General NPI Number Information
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NPI Number | 1649358508
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Entity Type | Organization
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Legal Business Name | CARDINAL CHIROPRACTIC INC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 401 HARBISON BLVD BLDG B SUITE 3
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City | COLUMBIA
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State | SC
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Zip | 29212-1716
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Country | US
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Telephone | 803-454-1096
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1322
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City | IRMO
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State | SC
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Zip | 29063-1322
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Country | US
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Telephone | 803-454-1096
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Fax | 803-749-0050
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Authorized Official
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Title or Position | CEO
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Name | DR. JESSICA A CARDINAL
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Credential | DC
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Telephone | 803-454-1096
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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 | 2340
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License Number State | SC
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